Organization
SUPPLEMENTAL HEATH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY NICOLE KISER OTR (OCCUPATIONAL THERAPIST)
(314) 703-5619
Entity
Organization
Contact information
Practice address
1520 LEGACY CIR, FENTON, MO 63026-2378
(314) 703-5619
Mailing address
1520 LEGACY CIR, FENTON, MO 63026-2378
(314) 703-5619
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2002015687
MO
Other
Enumeration date
03/29/2007
Last updated
08/22/2020
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