Healthcare Provider Details

I. General information

NPI: 1063570943
Provider Name (Legal Business Name): MRS. JEANNE MARIE KERR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23835 HIGHWAY 24
PARIS MO
65275-2276
US

IV. Provider business mailing address

6951 N SYCAMORE CREEK RD
ROCHEPORT MO
65279-9554
US

V. Phone/Fax

Practice location:
  • Phone: 660-327-1402
  • Fax:
Mailing address:
  • Phone: 573-874-0047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2004011323
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: