Individual
MRS. AMANDA FULLERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
2120 BRYAN VALLEY COMMERCIAL DR, O FALLON, MO 63366-3495
(314) 774-1859
Mailing address
411 COUNTRY DOWNS DR, LAKE SAINT LOUIS, MO 63367-4310
(314) 541-7938
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2010025352
MO
Other
Enumeration date
06/01/2011
Last updated
07/17/2019
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