Individual
NICOLE EWING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
850 COUNTRY MANOR LN, SAINT LOUIS, MO 63141-6651
(314) 434-5900
Mailing address
1211 PORT ROYAL DR, SAINT LOUIS, MO 63146-5637
(314) 991-3227
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2000144265
MO
Other
Enumeration date
11/28/2012
Last updated
11/28/2012
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