Provider Demographics
NPI:1275734261
Name:OTT, KELLY S (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:S
Last Name:OTT
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Gender:F
Credentials:MD
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Mailing Address - Street 1:6420 CLAYTON RD
Mailing Address - Street 2:DEPT. OF OB-GYN, SUITE 291
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1811
Mailing Address - Country:US
Mailing Address - Phone:314-781-4772
Mailing Address - Fax:314-645-8771
Practice Address - Street 1:6420 CLAYTON RD
Practice Address - Street 2:DEPT. OF OB-GYN, SUITE 291
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1811
Practice Address - Country:US
Practice Address - Phone:314-781-4772
Practice Address - Fax:314-645-8771
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MO2006016388207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology