Provider Demographics
NPI:1003958778
Name:PELIKAN, JENNIFER BETH (OTR)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BETH
Last Name:PELIKAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:BETH
Other - Last Name:MAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:15955 NEW HALLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-1227
Mailing Address - Country:US
Mailing Address - Phone:314-953-5000
Mailing Address - Fax:
Practice Address - Street 1:5323 VILLE MARIA LN
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1143
Practice Address - Country:US
Practice Address - Phone:314-770-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004698225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist