Provider Demographics
NPI:1851099691
Name:SAINT LOUIS, BAZELAIS (OTA/L)
Entity Type:Individual
Prefix:
First Name:BAZELAIS
Middle Name:
Last Name:SAINT LOUIS
Suffix:
Gender:M
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 PARK PLAZA DR APT 4302
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15229-3124
Mailing Address - Country:US
Mailing Address - Phone:484-378-5682
Mailing Address - Fax:
Practice Address - Street 1:550 S NEGLEY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1658
Practice Address - Country:US
Practice Address - Phone:484-813-6009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0P010357224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty