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General NPI Number Information
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NPI Number | 1992631626
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Entity Type | Organization
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Legal Business Name | OLIVE BRANCH PEDIATRIC SPECIALTIES LLC
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Dates
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Enumeration Date | 06/22/2026
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Last Update Date | 06/22/2026
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Provider Practice Location Address
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Address Line | 21450 HIGHWAY 32 STE A
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City | STE GENEVIEVE
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State | MO
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Zip | 63670-8814
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Country | US
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Telephone | 573-535-1061
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Fax |
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Provider Business Mailing Address
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Address Line | 11875 SCHULZE LN
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City | STE GENEVIEVE
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State | MO
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Zip | 63670-8816
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Country | US
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Telephone | 573-535-1061
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNA SUE KUEHN
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Credential | PTA
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Telephone | 573-535-1061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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