Provider Demographics
NPI:1730850041
Name:ICE, STEVEN (MOT, OT/L, CDRS)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:ICE
Suffix:
Gender:M
Credentials:MOT, OT/L, CDRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16639 WESTGLEN FARMS DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63011-1860
Mailing Address - Country:US
Mailing Address - Phone:314-920-0583
Mailing Address - Fax:
Practice Address - Street 1:16639 WESTGLEN FARMS DR
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63011-1860
Practice Address - Country:US
Practice Address - Phone:314-920-0583
Practice Address - Fax:636-821-1805
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-26
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004025105225XR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility