Healthcare Provider Details

I. General information

NPI: 1578341582
Provider Name (Legal Business Name): KATIE NEAL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/20/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1462 S. GRAND BLVD.
ST LOUIS MO
63104
US

IV. Provider business mailing address

25555 LOST CREEK RD
WARRENTON MO
63383-6418
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2023021528
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: