Healthcare Provider Details

I. General information

NPI: 1659144426
Provider Name (Legal Business Name): KRISTIN PERCY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12380 DE PAUL DR
BRIDGETON MO
63044-2511
US

IV. Provider business mailing address

2229 QUAINT COTTAGE DR
O FALLON MO
63368-7184
US

V. Phone/Fax

Practice location:
  • Phone: 314-447-9710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2023010730
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: