Healthcare Provider Details

I. General information

NPI: 1992631626
Provider Name (Legal Business Name): OLIVE BRANCH PEDIATRIC SPECIALTIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21450 HIGHWAY 32 STE A
STE GENEVIEVE MO
63670-8814
US

IV. Provider business mailing address

11875 SCHULZE LN
STE GENEVIEVE MO
63670-8816
US

V. Phone/Fax

Practice location:
  • Phone: 573-535-1061
  • Fax:
Mailing address:
  • Phone: 573-535-1061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: JENNA SUE KUEHN
Title or Position: OWNER
Credential: PTA
Phone: 573-535-1061