Provider Demographics
NPI:1255647772
Name:DAMKE, BETH ANN (COTA/L)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:DAMKE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 SCOTCH PINE TRL
Mailing Address - Street 2:
Mailing Address - City:FORISTELL
Mailing Address - State:MO
Mailing Address - Zip Code:63348-1522
Mailing Address - Country:US
Mailing Address - Phone:314-566-0282
Mailing Address - Fax:
Practice Address - Street 1:1 VILLAGE SQUARE CTR STE A
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1817
Practice Address - Country:US
Practice Address - Phone:314-731-4555
Practice Address - Fax:314-557-6110
Is Sole Proprietor?:No
Enumeration Date:2010-08-21
Last Update Date:2010-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009014390174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist