Provider Demographics
NPI:1750639613
Name:JAEGERS, TOSHA
Entity Type:Individual
Prefix:
First Name:TOSHA
Middle Name:
Last Name:JAEGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ST ELIZABETH
Mailing Address - State:MO
Mailing Address - Zip Code:65075-2440
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:649 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:ST ELIZABETH
Practice Address - State:MO
Practice Address - Zip Code:65075-2440
Practice Address - Country:US
Practice Address - Phone:314-543-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012023107224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO224Z00000XOtherOTA