Provider Demographics
NPI:1063194819
Name:FITZPATRICK, VITA MARIE (COTA/L)
Entity type:Individual
Prefix:
First Name:VITA
Middle Name:MARIE
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:VITA
Other - Middle Name:MARIE
Other - Last Name:POWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:456 N NEW BALLAS RD STE 211
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:456 N NEW BALLAS RD STE 211
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6842
Practice Address - Country:US
Practice Address - Phone:314-227-2124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023028203224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant