Samuel Mugwe Kimari, OTR/L
Individual provider Active NPI Specialist · St.Louis, MO
NPI 1629340765 · NPPES record last updated Feb 6, 2012
Key facts
- NPI
- 1629340765
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 004135 (MO)
- Practice address
- 11838 Orletto Way
St.Louis, MO 63138 - Phone
- (314) 757-0269
- NPI assigned
- Feb 6, 2012
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004135 | MO | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 004135 | MO | Yes |
Addresses
Primary practice location
11838 Orletto Way
St.Louis, MO 63138
Mailing address
11838 Orletto Way
St.Louis, MO 63138
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 056.004344 | Other | IL | OCCUPATIONAL LICENSE |
Other providers in St.Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.