Olivia Dawn Kernebeck
Individual provider Active NPI Pediatric Occupational Therapist · Imperial, MO
NPI 1528102001 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1528102001
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Occupational Therapist 225XP0200X
- License
- 005428 (MO)
- Practice address
- 3119 Valley Oaks Dr
Imperial, MO 63052-4364 - Phone
- (636) 461-2761
- NPI assigned
- Feb 16, 2007
- 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 |
|---|---|---|---|
| 005428 | MO | MD | Pediatric Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 005428 | MO | Yes |
Addresses
Primary practice location
3119 Valley Oaks Dr
Imperial, MO 63052-4364
Mailing address
3119 Valley Oaks Dr
Imperial, MO 63052-4364
Phone (636) 461-2761
Other providers in Imperial, MO
- Amber Hennrich
- Nathaniel B Hodges
- Thomas Davant Johns
- Charles J Johnson
- Junction Bracing & PT
- Courtney Jean Krake
- Jodee Lamp
- Daniel Christopher Leach
- Debra Lever
- Emily Mack
All providers in Imperial, MO · Pediatric 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 Jul 9, 2007. 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.