Healthcare Provider Details

I. General information

NPI: 1265635650
Provider Name (Legal Business Name): KRISTIN SHIMEL OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN SCHMIDT

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 CARROL DR
PLEASANT HILL MO
64080-1138
US

IV. Provider business mailing address

1404 CARROL DR
PLEASANT HILL MO
64080-1138
US

V. Phone/Fax

Practice location:
  • Phone: 816-651-1926
  • Fax:
Mailing address:
  • Phone: 816-651-1926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2004002122
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: