Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 32003331A | IN |
NPI | 1003462565 |
---|---|
Provider Name | Alexa Kelpe |
First Address | Sikeston, MO 63801-3960 |
Second Address | Sikeston, MO 63801-3960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2019 |
Last Update Date | 12/08/2019 |