Provider Demographics
NPI:1114122843
Name:KAUFMAN, JUDITH M (COTAL)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:M
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14120 WESTERNMILL DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2734
Mailing Address - Country:US
Mailing Address - Phone:314-878-7222
Mailing Address - Fax:314-878-7222
Practice Address - Street 1:312 SOLLEY DR
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-5248
Practice Address - Country:US
Practice Address - Phone:636-391-0666
Practice Address - Fax:636-256-1382
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000160902224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant