Individual
MS. PAMELA KIRAN DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
10176 CORPORATE SQUARE DR, SAINT LOUIS, MO 63132-2924
(314) 432-6200
(314) 849-2721
Mailing address
3529 SALENA ST, SAINT LOUIS, MO 63118-4024
(314) 477-5223
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2010005293
MO
Other
Enumeration date
06/19/2012
Last updated
06/19/2012
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