Provider Demographics
NPI:1245583707
Name:MORT, STEPHANIE ALYSSA (COTA)
Entity type:Individual
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First Name:STEPHANIE
Middle Name:ALYSSA
Last Name:MORT
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Gender:F
Credentials:COTA
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Mailing Address - Street 1:10176 CORPORATE SQUARE DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-2924
Mailing Address - Country:US
Mailing Address - Phone:314-432-6200
Mailing Address - Fax:314-432-8894
Practice Address - Street 1:10176 CORPORATE SQUARE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-2924
Practice Address - Country:US
Practice Address - Phone:314-432-6200
Practice Address - Fax:314-432-8894
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2023-11-16
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant