Provider Demographics
NPI:1124285887
Name:LANGE, MARIE KATHLEEN (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:KATHLEEN
Last Name:LANGE
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12063 RENAISSANCE DR
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-1145
Mailing Address - Country:US
Mailing Address - Phone:913-909-7495
Mailing Address - Fax:
Practice Address - Street 1:5030 MCREE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2046
Practice Address - Country:US
Practice Address - Phone:314-776-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007020783225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist