Individual
MS. JENNIFER A MANCUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
5943 TELEGRAPH RD, SAINT LOUIS, MO 63129-4715
(314) 375-1025
Mailing address
5943 TELEGRAPH RD., ST. LOUIS, MO 63129
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
005356
MO
Other
Enumeration date
07/19/2007
Last updated
07/19/2007
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