Provider Demographics
NPI:1740489608
Name:KUZNETSOV, MARINA (OTR)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:KUZNETSOV
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 1:13173 BELLERIVE FARM DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6099
Mailing Address - Country:US
Mailing Address - Phone:314-786-5142
Mailing Address - Fax:
Practice Address - Street 1:13173 BELLERIVE FARM DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6099
Practice Address - Country:US
Practice Address - Phone:314-786-5142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013007892225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist