Provider Demographics
NPI:1194382242
Name:DINEEN, MADELINE (MSOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:DINEEN
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:
Other - Last Name:KUERZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOT, OTR/L
Mailing Address - Street 1:6417 JANUARY AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-3714
Mailing Address - Country:US
Mailing Address - Phone:314-791-2988
Mailing Address - Fax:
Practice Address - Street 1:6022 S LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7019
Practice Address - Country:US
Practice Address - Phone:314-845-7751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017036849225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist