Provider Demographics
NPI:1316416951
Name:MATHIEU MCEVOY, JAIME M (MSOT)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:M
Last Name:MATHIEU MCEVOY
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:M
Other - Last Name:MATHIEU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2937 S BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-2713
Practice Address - Country:US
Practice Address - Phone:314-961-3804
Practice Address - Fax:314-961-1147
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
MO2019004539225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist