Individual
EDGAR MICERE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 PAUL PLACE CT, FLORISSANT, MO 63031
(314) 570-1944
Mailing address
1 PAUL PLACE CT, FLORISSANT, MO 63031
(314) 570-1944
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2008034717
MO
Other
Enumeration date
12/20/2013
Last updated
12/20/2013
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