Provider Demographics
NPI:1609918143
Name:WECKHERLIN, NICOLE THUY (OTR)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:THUY
Last Name:WECKHERLIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 TOP NOTCH LN
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1046
Mailing Address - Country:US
Mailing Address - Phone:636-938-3318
Mailing Address - Fax:
Practice Address - Street 1:2 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-2715
Practice Address - Country:US
Practice Address - Phone:314-241-0993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004748225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist