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Individual

AJA BETHANY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR

Contact information

Practice address
10600 LEWIS AND CLARK BLVD, SAINT LOUIS, MO 63136-6005
(314) 283-6955
Mailing address
5368 SUNTRAIL DR, BLACK JACK, MO 63033-4425
(314) 283-6955

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2006003768
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2006003768
STATE LICENSE
MO
Enumeration date
03/27/2012
Last updated
12/11/2025
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