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NPI Code Detail

MEDICARE: DR. KELLY MAUREEN DEEKER OTD

MEDICARE: DR. KELLY MAUREEN DEEKER OTD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist056006939IL
2225X00000XOccupational Therapist2003023377MO

General Provider Information

NPI Number : 1801938303
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLY MAUREEN DEEKER OTD
Provider Business Mailing Address
First Line : 63 LONG BRANCH LN
Second Line :
City : CASEYVILLE
State : IL
Zip : 62232-2854
Country : US
Telephone Number : 618-581-3977
Fax Number :
Provider Business Practice Location Address
First Line : 16020 SWINGLEY RIDGE RD STE 130
Second Line :
City : CHESTERFIELD
State : MO
Zip : 63017-2085
Country : US
Telephone Number : 618-581-3977
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2007
Last Update Date : 07/29/2019

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