Individual
MRS. JACQUELINE GRIEVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
315 PARK ST, TROY, IL 62294-1908
(314) 438-9463
Mailing address
315 PARK ST, TROY, IL 62294-1908
(314) 438-9463
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2005040623
DEPARTMENT OF PROFESSIONA
MO
Enumeration date
07/11/2007
Last updated
07/11/2007
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