Provider Demographics
NPI:1063690550
Name:ZIMMERMAN, MICHELE MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:MARIE
Last Name:ZIMMERMAN
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 VENNEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-4625
Mailing Address - Country:US
Mailing Address - Phone:314-660-8546
Mailing Address - Fax:
Practice Address - Street 1:407 VENNEMAN AVE
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-4625
Practice Address - Country:US
Practice Address - Phone:314-660-8546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2025-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007004534225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics