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Individual

NICOLE ALENA ALTHAGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA/L

Contact information

Practice address
1370 SHALLOW LAKE DR, O FALLON, MO 63366-3711
(314) 496-3820
Mailing address
1370 SHALLOW LAKE DR, O FALLON, MO 63366-3711
(314) 496-3820

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2023036837
MO

Other

Enumeration date
09/18/2023
Last updated
09/18/2023
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