Active NPI
Kelly B Carr
- Occupational Therapist
- Saint Louis, MO
National Provider Identifier
1669037719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 20100023527
- Practice address
- 4455 Duncan Ave
Saint Louis, MO 63110-1111 - Phone
- (314) 517-0229
- NPI assigned
- May 3, 2019
- Last updated
- May 3, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 20100023527 | MO | Primary |
Addresses
Primary practice location
4455 Duncan Ave
Saint Louis, MO 63110-1111
Mailing address
1024 Fairmount Ave
Saint Louis, MO 63139-3325
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20100023527 | Other | MO | TO STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20100023527 | MO | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556841600000",
"number": "1669037719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1024 FAIRMOUNT AVE",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631393325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4455 DUNCAN AVE",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631101111",
"telephone_number": "314-517-0229"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARR",
"first_name": "KELLY",
"middle_name": "B",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-03",
"last_updated": "2019-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MO",
"license": "20100023527",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TO STATE LICENSE",
"identifier": "20100023527",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.