Provider Demographics
NPI:1427383967
Name:THELE, ELIZABETH REE (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:REE
Last Name:THELE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:REE
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:3667 WILMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-3217
Mailing Address - Country:US
Mailing Address - Phone:314-305-0656
Mailing Address - Fax:
Practice Address - Street 1:3667 WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-3217
Practice Address - Country:US
Practice Address - Phone:314-305-0656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013021046225X00000X
KYR4294225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist