Provider Demographics
NPI:1013089564
Name:POHL, JODIE RAE
Entity Type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:RAE
Last Name:POHL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JODIE
Other - Middle Name:RAE
Other - Last Name:SCHWARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2837 BRIARCOTE LN
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-1705
Mailing Address - Country:US
Mailing Address - Phone:314-291-5456
Mailing Address - Fax:
Practice Address - Street 1:12120 CONWAY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8213
Practice Address - Country:US
Practice Address - Phone:314-251-7563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000161713225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist