Mary V Rackovan, COTA
Individual provider Active NPI Contractor · Saint Louis, MO
NPI 1891991964 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1891991964
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 004970 (MO)
- Practice address
- 7601 Watson Rd
Saint Louis, MO 63119-5001 - Phone
- (314) 961-8000
- NPI assigned
- Jun 25, 2007
- Sex
- Female
- 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 004970 | MO | Yes |
Addresses
Primary practice location
7601 Watson Rd
Saint Louis, MO 63119-5001
Mailing address
1236 S 9TH St
Saint Louis, MO 63104-3513
Phone (314) 255-8189
Other providers in Saint Louis, MO
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.