Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 200635505 | MO |
NPI | 1073038774 |
---|---|
Provider Name | Ms. Kathryn English Petri |
First Address | Arnold, MO 63010-6015 |
Second Address | Arnold, MO 63010-6015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2017 |
Last Update Date | 03/08/2017 |