| Lifetime Redesign Ot, Pllc | |
|
12395 Olive Blvd Ste 200 Saint Louis MO 63141-5465 | |
| (646) 319-9017 | |
| Not Available |
| Full Name | Lifetime Redesign Ot, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 12395 Olive Blvd Ste 200, Saint Louis, Missouri |
| Authorized Official Name and Position | Joseph Mitchell (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 2709934789 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifetime Redesign Ot, Pllc 1449 S Michigan Ave Ste 13138 Chicago IL 60605-2810 Ph: (646) 319-9017 | Lifetime Redesign Ot, Pllc 12395 Olive Blvd Ste 200 Saint Louis MO 63141-5465 Ph: (646) 319-9017 |
| NPI Number | 1013666403 |
|---|---|
| Provider Enumeration Date | 03/22/2022 |
| Last Update Date | 05/29/2025 |
| Certification Date | 05/29/2025 |
| Medicare PECOS PAC ID | 6901272244 |
|---|---|
| Medicare Enrollment ID | O20221012000608 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013666403 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Veronica A Kim |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1831481928 PECOS PAC ID: 9234316209 Enrollment ID: I20110601000165 |
| Provider Name | Justin M Chacko |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1922430743 PECOS PAC ID: 0547491177 Enrollment ID: I20140325001578 |
| Provider Name | Daniel Elliot |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1891209201 PECOS PAC ID: 3072871219 Enrollment ID: I20171218001955 |
| Provider Name | Heidi Richter |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1265071625 PECOS PAC ID: 0244666576 Enrollment ID: I20200205001990 |
| Provider Name | Walter Alexander Bryant |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1730794942 PECOS PAC ID: 0840601324 Enrollment ID: I20201205000105 |
| Provider Name | Julianne Messier |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1417347964 PECOS PAC ID: 5092100131 Enrollment ID: I20220328000936 |
| Provider Name | Sharonnda Baxter |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1891153201 PECOS PAC ID: 0941696090 Enrollment ID: I20220330000260 |
| Provider Name | Brendan Kiernan |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1689020638 PECOS PAC ID: 5597143115 Enrollment ID: I20220609001185 |
| Provider Name | Brittany Ferri |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1487188454 PECOS PAC ID: 0941683288 Enrollment ID: I20220818001731 |
| Provider Name | Alaina Nicole Dimitriou |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1033744461 PECOS PAC ID: 1355717695 Enrollment ID: I20221012000872 |
| Provider Name | Delia Thompson |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1447028667 PECOS PAC ID: 1557714748 Enrollment ID: I20240124000963 |
| Provider Name | Alana Natasia Zimmer |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1104521251 PECOS PAC ID: 5092258418 Enrollment ID: I20240613002647 |
| Provider Name | Mary Prostick |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1477611754 PECOS PAC ID: 8921544875 Enrollment ID: I20240726002674 |
| Provider Name | Mary Carter |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1740866854 PECOS PAC ID: 7113463977 Enrollment ID: I20240729002472 |
| Provider Name | Taylor Alvarez |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1043062805 PECOS PAC ID: 1153869466 Enrollment ID: I20240819000805 |
| Provider Name | Danielle Ferris |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1063759389 PECOS PAC ID: 2769913201 Enrollment ID: I20241008001815 |
| Provider Name | Paola G Chang |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1184443152 PECOS PAC ID: 6901333756 Enrollment ID: I20241218002553 |
| Provider Name | Rachel Harrington |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1669291423 PECOS PAC ID: 8325576317 Enrollment ID: I20250103000891 |
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