Provider Demographics
NPI:1730968744
Name:BRUEGGEMANN, ALICIA ANN
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANN
Last Name:BRUEGGEMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 VILLAGE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-6125
Mailing Address - Country:US
Mailing Address - Phone:636-584-5665
Mailing Address - Fax:
Practice Address - Street 1:8600 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1973
Practice Address - Country:US
Practice Address - Phone:636-545-5665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022043571225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist