Provider Demographics
NPI:1174236681
Name:UECKER, MARISSA KATHRYN
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:KATHRYN
Last Name:UECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6648 OAKLAND AVE APT 1S
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-3228
Mailing Address - Country:US
Mailing Address - Phone:317-560-0844
Mailing Address - Fax:
Practice Address - Street 1:2497 CREVE COEUR MILL RD
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-1199
Practice Address - Country:US
Practice Address - Phone:317-560-0844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer