Healthcare Provider Details

I. General information

NPI: 1649976234
Provider Name (Legal Business Name): KYLEE NICOLE FLYNN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 12/08/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 ELM ST
SAINT CHARLES MO
63301-1750
US

IV. Provider business mailing address

3101 SUN LAKE DR
SAINT CHARLES MO
63301-3050
US

V. Phone/Fax

Practice location:
  • Phone: 636-443-4500
  • Fax:
Mailing address:
  • Phone: 417-499-6739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2023002815
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: