Provider Demographics
NPI:1700991015
Name:MEYERS, MAURA CELLA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MAURA
Middle Name:CELLA
Last Name:MEYERS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:MAURA
Other - Middle Name:KATHLEEN
Other - Last Name:CELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:7733 FORSYTH BLVD
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105
Mailing Address - Country:US
Mailing Address - Phone:800-677-1238
Mailing Address - Fax:314-863-0769
Practice Address - Street 1:404 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026
Practice Address - Country:US
Practice Address - Phone:314-303-9568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002026731225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2002026731OtherLICENSE #