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Individual

JAQUELINE MARIA SHAFER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
105 BONNYBRIDGE CT, ELLISVILLE, MO 63021-4507
(314) 914-5000
Mailing address
105 BONNYBRIDGE CT, ELLISVILLE, MO 63021

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
005080
MO
225XE0001X
Environmental Modification Occupational Therapist
005080
MO

Other

Enumeration date
07/26/2017
Last updated
07/21/2022
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