Individual
SUSAN ANN WACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 MEDICAL PLZ, LAKE ST LOUIS, MO 63367-1366
(636) 755-3578
Mailing address
202 TOWNVIEW CT, WENTZVILLE, MO 63385-2925
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2005018057
MO
Other
Enumeration date
08/06/2024
Last updated
08/06/2024
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