Kelly Maureen Deeker, OTD

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

2003023377 Issued in MO

Practice address

16020 Swingley Ridge Rd Ste 130
Chesterfield, MO 63017-2085

Phone

(618) 581-3977

NPI assigned

Feb 12, 2007

Last updated

Jul 29, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Prorehab, PC

  dba Athletico Physical Therapy

  • Physical Therapy Clinic/Center
  • Edwardsville, IL
  • NPI 1851476378
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564358400000",
    "number": "1801938303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 LONG BRANCH LN",
            "city": "CASEYVILLE",
            "state": "IL",
            "postal_code": "622322854",
            "telephone_number": "618-581-3977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16020 SWINGLEY RIDGE RD STE 130",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630172085",
            "telephone_number": "618-581-3977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEEKER",
        "first_name": "KELLY",
        "middle_name": "MAUREEN",
        "name_prefix": "Dr.",
        "credential": "OTD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2019-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056006939",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MO",
            "license": "2003023377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelli E Dean Riegel, PA-C
• John Nicholas Deangelis, D.C.
• Katherine Deckelbaum, RPH
• Gregory M Decker, MD
• Ruth A Decker, MD
• Jane E Defalco, MD
• Bonnie Marie Define
• Ronald K Deguerre, MD
• Sierra Rose Deguire, AGACNP-BC
• Mario Del Frate, DC

• Occupational Therapist in Chesterfield, MO
• Providers in Chesterfield, MO by specialty
• Occupational Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 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.

Verify at the official NPI Registry.