Provider Demographics
NPI:1386953230
Name:BLUECOO, MADELEINE B (COTA)
Entity type:Individual
Prefix:MRS
First Name:MADELEINE
Middle Name:B
Last Name:BLUECOO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HARBOR BEND CT STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1480
Mailing Address - Country:US
Mailing Address - Phone:636-695-2070
Mailing Address - Fax:
Practice Address - Street 1:2 HARBOR BEND CT STE 102
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1480
Practice Address - Country:US
Practice Address - Phone:636-695-2070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010020208224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant