Individual
MR. TIMOTHY WAYNE PEMBERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
4921 PARKVIEW PL, DEPT OCCUPATIONAL THERAPY, STE 6F, SAINT LOUIS, MO 63110-1032
(314) 286-1669
(314) 747-3662
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(314) 286-1669
(314) 747-3662
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2018009363
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
470064153
—
MO
Enumeration date
09/18/2018
Last updated
04/17/2025
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