Provider Demographics
NPI:1831243823
Name:EDWARDS, EMILIE CLAIRE (MOT, OTR L)
Entity type:Individual
Prefix:MRS
First Name:EMILIE
Middle Name:CLAIRE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MOT, OTR L
Other - Prefix:MISS
Other - First Name:EMILIE
Other - Middle Name:CLAIRE
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:551 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4155
Mailing Address - Country:US
Mailing Address - Phone:312-401-0185
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6154
Practice Address - Fax:314-454-2380
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012001591225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist