Provider Demographics
NPI:1053853390
Name:NEICHTER, KILEY (MOTR/L)
Entity type:Individual
Prefix:
First Name:KILEY
Middle Name:
Last Name:NEICHTER
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18735 WILD HORSE FARM CT
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63038-1186
Mailing Address - Country:US
Mailing Address - Phone:217-710-0482
Mailing Address - Fax:
Practice Address - Street 1:1395 JUNGERMANN RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-7369
Practice Address - Country:US
Practice Address - Phone:636-485-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.011139225X00000X
MO2018024878225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist