Individual
TARA BRUNS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6427 BRADLEY AVE REAR, SAINT LOUIS, MO 63139-2203
(314) 368-2954
Mailing address
6427 BRADLEY AVE REAR, SAINT LOUIS, MO 63139-2203
(314) 368-2954
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2017038263
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TB73967
USERNAME
MO
Enumeration date
12/02/2021
Last updated
12/02/2021
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