Individual
KISCHA MOTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3019 LINCOLN AVE, EAST SAINT LOUIS, IL 62204-1110
(618) 581-6638
Mailing address
3019 LINCOLN AVE, EAST SAINT LOUIS, IL 62204-1110
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057003075
IL
224Z00000X
Occupational Therapy Assistant
2009012937
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
107216491
—
IL
Enumeration date
06/01/2012
Last updated
06/01/2012
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