Individual
KELLY B CARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4455 DUNCAN AVE, SAINT LOUIS, MO 63110-1111
(314) 517-0229
Mailing address
1024 FAIRMOUNT AVE, SAINT LOUIS, MO 63139-3325
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
20100023527
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20100023527
TO STATE LICENSE
MO
Enumeration date
05/03/2019
Last updated
05/03/2019
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