Individual
MR. LA ATIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
1065 DAUPHIN LN, FLORISSANT, MO 63033
(314) 630-7326
Mailing address
1065 DAUPHIN LN, FLORISSANT, MO 63033-5929
(314) 630-7326
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2012006010
MO
Other
Enumeration date
08/08/2012
Last updated
08/08/2012
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