Provider Demographics
NPI:1477924504
Name:ST PIERRE, MISTI (COTA/L 14505)
Entity Type:Individual
Prefix:
First Name:MISTI
Middle Name:
Last Name:ST PIERRE
Suffix:
Gender:F
Credentials:COTA/L 14505
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 SE 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1055
Mailing Address - Country:US
Mailing Address - Phone:239-298-0561
Mailing Address - Fax:239-673-9095
Practice Address - Street 1:146 SE 5TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1055
Practice Address - Country:US
Practice Address - Phone:239-298-0561
Practice Address - Fax:239-673-9095
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14505224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant