Individual
KATIE BUBLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1020 WOODS MILL RD, TOWN AND COUNTRY, MO 63017-3106
(314) 412-0296
Mailing address
418 HAMILTON MEADOWS DR, FENTON, MO 63026-3987
(314) 412-0296
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2016004132
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NOT APPLICABLE
—
Enumeration date
07/15/2020
Last updated
07/15/2020
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