Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1999137887 | MO |
N | 225XH1200X | Occupational Therapist - Hand | 1061100879 |
NPI | 1275104028 |
---|---|
Provider Name | Kelly Bini |
First Address | St. Louis, MO 63146 |
Second Address | St. Louis, MO 63146 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2021 |
Last Update Date | 02/07/2021 |