Healthcare Provider Details

I. General information

NPI: 1255244810
Provider Name (Legal Business Name): ISABELLA KATHLEEN KETTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CRAIG RD STE 127
MARYLAND HEIGHTS MO
63146
US

IV. Provider business mailing address

110 CRAIG RD STE 127
MARYLAND HEIGHTS MO
63146
US

V. Phone/Fax

Practice location:
  • Phone: 305-375-3878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-545841
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: