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General NPI Number Information
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NPI Number | 1437939923
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Entity Type | Individual
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Provider Name | KAILEY PELLERITO
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Gender | Female
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 139 COLE BLVD
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City | SAINT CHARLES
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State | MO
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Zip | 63301-0412
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Country | US
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Telephone | 636-293-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 139 COLE BLVD
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City | SAINT CHARLES
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State | MO
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Zip | 63301-0412
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Country | US
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Telephone | 636-293-3600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 2023037118
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License Number State | MO
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