Individual
MRS. TANQUERAE KISSY-VIRGINIA COLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
4401 N HANLEY RD, BERKELEY, MO 63134-2710
(314) 521-7471
Mailing address
1218 SELLS AVE, SAINT LOUIS, MO 63147-1506
(314) 642-5558
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2010026845
MO
Other
Enumeration date
05/31/2012
Last updated
05/31/2012
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