Dusty R Kaesberg, COTA
Individual provider Active NPI Occupational Therapy Assistant · Red Bud, IL
NPI 1508019787 · NPPES record last updated Oct 31, 2008
Key facts
- NPI
- 1508019787
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 057002965 (IL)
- Practice address
- 11093 N Prairie Rd
Red Bud, IL 62278-4372 - Phone
- (618) 910-1382
- NPI assigned
- Oct 31, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 057002965 | IL | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 057002965 | IL | Yes |
Addresses
Primary practice location
11093 N Prairie Rd
Red Bud, IL 62278-4372
Mailing address
11093 N Prairie Rd
Red Bud, IL 62278-4372
Phone (618) 910-1382
Other providers in Red Bud, IL
- Katelyn Houba
- Human Service Center
- Human Service Center of Southern Metro-East
- Interior Plains Emergency Physicians
- Inwood Emergency Physicians, LLC
- Crystal Keeling
- Julie L Kelley
- Chung Khan
- Jennifer Kimbrell
- Jennifer Knott
All providers in Red Bud, IL · Occupational Therapy Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2008. 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.