Jon Thomas Whitehead
Individual provider Active NPI Occupational Therapist · St. Loius, MO
NPI 1811096886 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1811096886
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 001533 (MO)
- Practice address
- 4144 Lindell Blvd
Suite 310
St. Loius, MO 63108 - Phone
- (314) 531-8224
- Fax
- (314) 531-5683
- NPI assigned
- Sep 22, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131218001319 | MO | Practitioner - Occupational Therapist in Private Practice | 0941291660 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Access One Healthcare LLC | Current |
Accepting new patients |
Locations
8123 Delmar Blvd
#200
University City, MO 63130
Phone (314) 498-2776
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 001533 | MO | Yes |
Addresses
Primary practice location
4144 Lindell Blvd
Suite 310
St. Loius, MO 63108
Mailing address
4144 Lindell Blvd
Suite 310
St. Loius, MO 63108
Phone (314) 531-8224
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5357960001 | Medicaid | MO |
Other providers in St. Loius, MO
All providers in St. Loius, MO · Occupational Therapist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.