Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 2005028265 | MO |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 2005028265 | MO |
NPI | 1285170209 |
---|---|
Provider Name | Mrs. Kelly Ann Fiala |
First Address | Dardenne Prairie, MO 63368-8376 |
Second Address | Saint Peters, MO 63376-1369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2017 |
Last Update Date | 28/07/2020 |