Individual provider Active NPI

Michele Marie Zimmerman, OTR/L

  • Pediatric Occupational Therapist
  • Saint Louis, MO
National Provider Identifier
1063690550
Registry record updated Mar 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
2007004534 Issued in MO
Practice address
407 Venneman Ave
St. Louis, MO 63122-4625
Phone
(314) 660-8546
NPI assigned
Feb 6, 2008
Last updated
Mar 2, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 2, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X 2007004534 MO Primary

Addresses

Primary practice location

407 Venneman Ave
St. Louis, MO 63122-4625

Mailing address

407 Venneman Ave
St. Louis, MO 63122-4625
Phone (314) 660-8546

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2007004534MOMDPediatric Occupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1202256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740873600000",
    "number": "1063690550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 VENNEMAN AVE",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "631224625",
            "telephone_number": "314-660-8546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 VENNEMAN AVE",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "631224625",
            "telephone_number": "314-660-8546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZIMMERMAN",
        "first_name": "MICHELE",
        "middle_name": "MARIE",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-02-06",
        "last_updated": "2025-03-02",
        "certification_date": "2025-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "MO",
            "license": "2007004534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.