Individual provider Active NPI

Laura Siddle, MOT/R, CLC

  • Occupational Therapist
  • Saint Charles, MO
National Provider Identifier
1063162014
Registry record updated Mar 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
2014024526 Issued in MO
Practice address
2150 W Randolph St
Saint Charles, MO 63301-0844
Phone
(636) 946-4966
NPI assigned
Mar 24, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 2014024526 MO Primary

Addresses

Primary practice location

2150 W Randolph St
Saint Charles, MO 63301-0844

Mailing address

3029 Country Knoll Dr
Saint Charles, MO 63303-6368
Phone (636) 359-5540

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220331000755 MO Practitioner - Occupational Therapist in Private Practice 8820484868 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1051 Kent St
Liberty, MO 64068-2257
Phone (816) 370-5242

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2014024526MOMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Empowerme Wellness Kansas City, LLC Occupational Therapist CurrentSince Mar 28, 2022 Accepting new patients
Empowerme Wellness Kansas City, LLC CurrentSince Mar 28, 2022 Accepting new patients
Empowerme Rehabilitation Missouri LLC Occupational Therapist CurrentSince Mar 28, 2022 Accepting new patients
Empowerme Rehabilitation Missouri LLC Occupational Therapist CurrentSince Mar 28, 2022 Accepting new patients

Locations

16255 Chesterfield Pkwy W
Chesterfield, MO 63017
Phone (636) 812-6942

3002 John Duffy Dr
Joplin, MO 64804
Phone (417) 553-9767

135 Meadowlands Estates Ln
O Fallon, MO 63366
Phone (636) 614-0036

2150 W Randolph St
Saint Charles, MO 63301
Phone (636) 946-4966

1335 Strassner Dr
Saint Louis, MO 63144
Phone (314) 673-6723

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648080000000",
    "number": "1063162014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3029 COUNTRY KNOLL DR",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633036368",
            "telephone_number": "636-359-5540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 W RANDOLPH ST",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633010844",
            "telephone_number": "636-946-4966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDLE",
        "first_name": "LAURA",
        "credential": "MOT/R, CLC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-24",
        "last_updated": "2022-03-24",
        "certification_date": "2022-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MO",
            "license": "2014024526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Charles, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.