Provider Demographics
NPI:1992815948
Name:CARPENTER, CIA PASSIG (OT)
Entity type:Individual
Prefix:MS
First Name:CIA
Middle Name:PASSIG
Last Name:CARPENTER
Suffix:
Gender:
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:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-286-1669
Mailing Address - Fax:314-747-3662
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DEPT OCCUPATIONAL THERAPY, STE 6F
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-286-1669
Practice Address - Fax:314-747-3662
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001245225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO470052015Medicaid