Provider Demographics
NPI:1215047345
Name:THEISS, VICTORIA KAY (MS OTRL)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:KAY
Last Name:THEISS
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:KAY
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:774 WALNUT RIDGE
Mailing Address - Street 2:
Mailing Address - City:FENHON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-5444
Mailing Address - Country:US
Mailing Address - Phone:636-343-1215
Mailing Address - Fax:
Practice Address - Street 1:3950 VOGEL RD
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010
Practice Address - Country:US
Practice Address - Phone:636-461-0900
Practice Address - Fax:636-461-0047
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004065225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist