Provider Demographics
NPI:1447764915
Name:MOWRY, TRICIA DIANE (COTA)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:DIANE
Last Name:MOWRY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-2559
Mailing Address - Country:US
Mailing Address - Phone:314-713-7939
Mailing Address - Fax:
Practice Address - Street 1:12826 DAYLIGHT CIR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1890
Practice Address - Country:US
Practice Address - Phone:314-792-0514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012019404224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty