Individual
MISS KATELYN MARIE KELLAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
8745 JAMES A REED RD, RAYTOWN, MO 64138-4414
(816) 761-4744
Mailing address
114 W MAIN ST, PORTAGEVILLE, MO 63873-1620
(573) 450-7280
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
404281
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2018026320
STATE LICENSED OCCUPATIONAL THERAPIST
MO
01
—
404281
OCCUPATIONAL THERAPIST REGISTERED
—
Enumeration date
09/12/2018
Last updated
09/12/2018
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