Provider Demographics
NPI:1285983031
Name:BREWER, SHIRLEY LOUISE (OT)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:LOUISE
Last Name:BREWER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 BELLARMINE LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-7323
Mailing Address - Country:US
Mailing Address - Phone:314-803-1089
Mailing Address - Fax:
Practice Address - Street 1:1020 BELLARMINE LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-7323
Practice Address - Country:US
Practice Address - Phone:314-803-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000174557225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist