Healthcare Provider Details

I. General information

NPI: 1477837292
Provider Name (Legal Business Name): KEVIN TERRY TEMPLIN OPA-C, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14825 N OUTER 40 RD SUITE 200
CHESTERFIELD MO
63017-2152
US

IV. Provider business mailing address

14825 N OUTER 40 RD SUITE 200
CHESTERFIELD MO
63017-2152
US

V. Phone/Fax

Practice location:
  • Phone: 314-336-2555
  • Fax: 314-336-2655
Mailing address:
  • Phone: 314-336-2555
  • Fax: 314-336-2655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: