Provider Demographics
NPI:1003926130
Name:PIETROBURGO, ANN HEATH (OTR CHT)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:HEATH
Last Name:PIETROBURGO
Suffix:
Gender:F
Credentials:OTR CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 NIRK AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122
Mailing Address - Country:US
Mailing Address - Phone:314-965-2136
Mailing Address - Fax:
Practice Address - Street 1:4600 CHIPPEWA
Practice Address - Street 2:STE F
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116
Practice Address - Country:US
Practice Address - Phone:314-351-7172
Practice Address - Fax:314-351-6885
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004321225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand