Healthcare Provider Details

I. General information

NPI: 1154743516
Provider Name (Legal Business Name): KALLI PRICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2014
Last Update Date: 01/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 VERMILLION ST
CENTERVILLE SD
57014-2168
US

IV. Provider business mailing address

500 VERMILLION ST
CENTERVILLE SD
57014-2168
US

V. Phone/Fax

Practice location:
  • Phone: 605-563-2251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number303A
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: