Provider Demographics
NPI:1952455651
Name:OPPENHEIM, BETH ANN (OTR)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:OPPENHEIM
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 1:900 FAIRDALE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-1222
Mailing Address - Country:US
Mailing Address - Phone:314-968-4549
Mailing Address - Fax:314-968-4549
Practice Address - Street 1:900 FAIRDALE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-1222
Practice Address - Country:US
Practice Address - Phone:314-968-4549
Practice Address - Fax:314-968-4549
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000046225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics