Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 2001033077 | MO |
NPI | 1588331987 |
---|---|
Provider Name | Kelly Lohaus |
First Address | Saint Charles, MO 63301-1936 |
Second Address | Saint Charles, MO 63301-1646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2021 |
Last Update Date | 24/08/2021 |