Provider Demographics
NPI:1679986590
Name:KEUL, KATELYN CAROL LOUISE (COTA/L)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:CAROL LOUISE
Last Name:KEUL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4165 MILLERS RIDGE
Mailing Address - Street 2:
Mailing Address - City:ST. CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304
Mailing Address - Country:US
Mailing Address - Phone:660-281-0096
Mailing Address - Fax:
Practice Address - Street 1:4165 MILLERS RDG
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-7765
Practice Address - Country:US
Practice Address - Phone:660-281-0096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2014002502224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2045Medicaid