Individual
MARY V RACKOVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
7601 WATSON RD, SAINT LOUIS, MO 63119-5001
(314) 961-8000
Mailing address
1236 S 9TH ST, SAINT LOUIS, MO 63104-3513
(314) 255-8189
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
004970
MO
Other
Enumeration date
06/25/2007
Last updated
07/08/2007
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