Individual
CAROL PONCIROLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4637 PERSHING PL, SAINT LOUIS, MO 63108-1907
(314) 361-6965
Mailing address
4637 PERSHING PL, SAINT LOUIS, MO 63108-1907
(314) 361-6965
Taxonomy
Speciality
Code
Description
License number
State
225XN1300X
Neurorehabilitation Occupational Therapist
Primary
000498
MO
Other
Enumeration date
04/17/2017
Last updated
04/17/2017
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