Provider Demographics
NPI:1356446256
Name:FIALA, JEAN M (OTR/L CHT)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:M
Last Name:FIALA
Suffix:
Gender:F
Credentials:OTR/L CHT
Other - Prefix:MISS
Other - First Name:JEAN
Other - Middle Name:M
Other - Last Name:EPSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:11433 OLDE CABIN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7136
Mailing Address - Country:US
Mailing Address - Phone:314-432-4080
Mailing Address - Fax:
Practice Address - Street 1:11433 OLDE CABIN RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7136
Practice Address - Country:US
Practice Address - Phone:314-432-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000312225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand