MEDICARE: MRS. ALLISON KELLEY OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	3051	NE

General Provider Information

NPI Number	:	1205713807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALLISON KELLEY OTR/L

Provider Business Mailing Address
First Line	:	12400 OLIVE BLVD STE 425
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-5458
Country	:	US
Telephone Number	:	314-275-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	12400 OLIVE BLVD STE 425
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-5458
Country	:	US
Telephone Number	:	314-275-9000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2025
Last Update Date	:	01/29/2026

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