Kelly Ann Fiala, MOTR/L
Individual provider Active NPI Gerontology Occupational Therapist · New Madrid, MO
NPI 1285170209 · NPPES record last updated Sep 11, 2024
Key facts
- NPI
- 1285170209
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gerontology Occupational Therapist 225XG0600X
- License
- 2005028265 (MO)
- Practice address
- 35 Villa Shopping Ctr
New Madrid, MO 63869-1230 - Phone
- (573) 621-3126
- NPI assigned
- Jan 14, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2005028265 | MO | MD | Gerontology Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sovereign Healthcare Group, LLC | Current |
Accepting new patients | |
| Phoenix Home Care, LLC | Past | Accepting new patients |
Locations
35 Villa Shopping Ctr
New Madrid, MO 63869
Phone (573) 621-3126
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Rehabilitation Occupational Therapist | 225XP0019X | 2005028265 | MO | |
| Gerontology Occupational Therapist | 225XG0600X | 2005028265 | MO | Yes |
Addresses
Primary practice location
35 Villa Shopping Ctr
New Madrid, MO 63869-1230
Mailing address
630 Knollshire Way
Dardenne Prairie, MO 63368-8376
Phone (636) 695-4330
Other providers in New Madrid, MO
- Family Matters Home Services LLC
- Family Matters Home Services LLC
- Family Matters Home Services LLC
- Family Matters in Home LLC
- Ferguson Medical Group Rural Health Center, Inc
- Freds Stores of Tennessee Inc
- Carrie L Gregory
- Christine Grissom
- Guardian Home Health Care LLC
- Health Facilities Rehab Services Inc
All providers in New Madrid, MO · Gerontology Occupational Therapist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.