Healthcare Provider Details

I. General information

NPI: 1801879432
Provider Name (Legal Business Name): KAY RABBITT PARK AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

9888 OLD WARSON RD
SAINT LOUIS MO
63124-1068
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-4847
  • Fax: 314-251-5992
Mailing address:
  • Phone: 314-251-4847
  • Fax: 314-251-5992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1053
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: