Basic Information
| Provider Information | |||||||||
| NPI: | 1508528571 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCURREN | ||||||||
| FirstName: | LYDIA | ||||||||
| MiddleName: | ANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1123 RAINBOW DR | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631253514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146033192 | ||||||||
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| Practice Location | |||||||||
| Address1: | 950 FRANCIS PL STE 115 | ||||||||
| Address2: | |||||||||
| City: | CLAYTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631052465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146441978 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2021 | ||||||||
| LastUpdateDate: | 10/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.