Provider Demographics
NPI:1093915951
Name:KINWORTHY, TONI FAYE (OTR)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:FAYE
Last Name:KINWORTHY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5134 AUTUMN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-1585
Mailing Address - Country:US
Mailing Address - Phone:636-296-3686
Mailing Address - Fax:
Practice Address - Street 1:7733 FORSYTH BLVD
Practice Address - Street 2:SUITE 2300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-1817
Practice Address - Country:US
Practice Address - Phone:800-677-1238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004069225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist