Provider Demographics
NPI:1376681361
Name:TAMAYO-TSO, FREDIZMINDA CASTILLO (OTL)
Entity Type:Individual
Prefix:MRS
First Name:FREDIZMINDA
Middle Name:CASTILLO
Last Name:TAMAYO-TSO
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:FREDIZMINDA
Other - Middle Name:CASTILLO
Other - Last Name:TAMAYO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTL
Mailing Address - Street 1:2366 CEDAR LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043
Mailing Address - Country:US
Mailing Address - Phone:314-576-7327
Mailing Address - Fax:
Practice Address - Street 1:2555 HACKMANN RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5452
Practice Address - Country:US
Practice Address - Phone:636-851-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0032792225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist