Provider Demographics
NPI:1033344304
Name:KAELIN, TERESA MARY
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARY
Last Name:KAELIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3291 W. RIDGE RUN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:65810
Mailing Address - Country:US
Mailing Address - Phone:417-883-1185
Mailing Address - Fax:
Practice Address - Street 1:3291 W. RIDGE RUN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810
Practice Address - Country:US
Practice Address - Phone:417-883-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003007816225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist