Provider Demographics
NPI:1881867091
Name:COSTIGAN, CARRIE ELIZABETH (OTRL)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:ELIZABETH
Last Name:COSTIGAN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MS
Other - First Name:CARRIE
Other - Middle Name:COSTIGAN
Other - Last Name:SOCOLOF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:11701 BORMAN DR
Mailing Address - Street 2:STE 280
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146
Mailing Address - Country:US
Mailing Address - Phone:314-983-9555
Mailing Address - Fax:314-983-9444
Practice Address - Street 1:4455 DUNCAN AVE
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110
Practice Address - Country:US
Practice Address - Phone:314-658-3800
Practice Address - Fax:314-633-8419
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999134938225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist