Provider Demographics
NPI:1548302672
Name:ALLARD, THERESA MARIE
Entity type:Individual
Prefix:MISS
First Name:THERESA
Middle Name:MARIE
Last Name:ALLARD
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 1:11923 HOLLY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-1347
Mailing Address - Country:US
Mailing Address - Phone:314-770-9054
Mailing Address - Fax:
Practice Address - Street 1:15089 MANOR CREEK DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-7717
Practice Address - Country:US
Practice Address - Phone:314-941-5765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005014225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist