Healthcare Provider Details

I. General information

NPI: 1043621436
Provider Name (Legal Business Name): CAITLYN KEELER MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N SAINT JOE DR
PARK HILLS MO
63601-1965
US

IV. Provider business mailing address

1301 N SAINT JOE DR
PARK HILLS MO
63601-1965
US

V. Phone/Fax

Practice location:
  • Phone: 573-431-2889
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2014006806
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: