Provider Demographics
NPI:1154837284
Name:OSTRANDER, MOIRA ANNE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:MOIRA
Middle Name:ANNE
Last Name:OSTRANDER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 N CLOVERLEAF DR STE J
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6436
Mailing Address - Country:US
Mailing Address - Phone:636-922-4700
Mailing Address - Fax:636-922-4505
Practice Address - Street 1:4200 N CLOVERLEAF DR STE J
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6436
Practice Address - Country:US
Practice Address - Phone:636-922-4700
Practice Address - Fax:636-922-4505
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016037453225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant