Steven Ice, MOT, OT/L, CDRS

Primary specialty

Driving and Community Mobility Occupational TherapistTaxonomy code 225XR0403X

License

2004025105 Issued in MO

Practice address

16639 Westglen Farms Dr
Wildwood, MO 63011-1860

Phone

(314) 920-0583

Fax

(636) 821-1805

NPI assigned

Sep 26, 2021

Last updated

Sep 26, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1632614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632614400000",
    "number": "1730850041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16639 WESTGLEN FARMS DR",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "630111860",
            "telephone_number": "314-920-0583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16639 WESTGLEN FARMS DR",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "630111860",
            "telephone_number": "314-920-0583",
            "fax_number": "636-821-1805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ICE",
        "first_name": "STEVEN",
        "name_prefix": "Mr.",
        "credential": "MOT, OT/L, CDRS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-09-26",
        "last_updated": "2021-09-26",
        "certification_date": "2021-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XR0403X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Driving and Community Mobility",
            "state": "MO",
            "license": "2004025105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Wildwood, MO
• Providers in Wildwood, MO by specialty
• Occupational Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2021; 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.