Provider Demographics
NPI:1629436456
Name:BLECHLE, BETH ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:BLECHLE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 EXECUTIVE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2594
Mailing Address - Country:US
Mailing Address - Phone:636-922-7600
Mailing Address - Fax:
Practice Address - Street 1:5400 EXECUTIVE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2594
Practice Address - Country:US
Practice Address - Phone:636-922-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.003607225X00000X
MO005097225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist