Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2015008533 | MO |
NPI | 1003287707 |
---|---|
Provider Name | Kelsey Lynn Yeary |
First Address | Saint Louis, MO 63118-1306 |
Second Address | Florissant, MO 63031-6716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2015 |
Last Update Date | 08/10/2015 |