Provider Demographics
NPI:1417105016
Name:JAEGERS, LISA A
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:JAEGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 KUHL AVE
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-2116
Mailing Address - Country:US
Mailing Address - Phone:636-456-4311
Mailing Address - Fax:
Practice Address - Street 1:302 KUHL AVE
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-2116
Practice Address - Country:US
Practice Address - Phone:636-456-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist