Provider Demographics
NPI:1003409848
Name:FORTH, MONICA ELAINE (MOT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ELAINE
Last Name:FORTH
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:ELAINE
Other - Last Name:G'SELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16216 BAXTER RD STE 330
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-4778
Mailing Address - Country:US
Mailing Address - Phone:636-733-3330
Mailing Address - Fax:636-733-3332
Practice Address - Street 1:16216 BAXTER RD STE 330
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4778
Practice Address - Country:US
Practice Address - Phone:636-733-3330
Practice Address - Fax:636-733-3332
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist