Individual
TAYLOR WILDERMUTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
12110 CLAYTON RD, SAINT LOUIS, MO 63131-2599
(314) 989-8100
Mailing address
12501 LIGHTHOUSE WAY DR APT G, CREVE COEUR, MO 63141-5401
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2024009244
MO
Other
Enumeration date
08/02/2024
Last updated
08/02/2024
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