Healthcare Provider Details

I. General information

NPI: 1588331987
Provider Name (Legal Business Name): KELLY LOHAUS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 1ST CAPITOL DR
SAINT CHARLES MO
63301-1646
US

IV. Provider business mailing address

811 N 5TH ST
SAINT CHARLES MO
63301-1936
US

V. Phone/Fax

Practice location:
  • Phone: 314-750-4643
  • Fax:
Mailing address:
  • Phone: 314-750-4643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number2001033077
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: