Provider Demographics
NPI:1619540887
Name:VAN EPS, KAILEY JO (OT)
Entity Type:Individual
Prefix:
First Name:KAILEY
Middle Name:JO
Last Name:VAN EPS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:BIG STONE CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57216-8237
Mailing Address - Country:US
Mailing Address - Phone:605-541-1140
Mailing Address - Fax:605-541-0109
Practice Address - Street 1:30 S BEHL ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:MN
Practice Address - Zip Code:56208-1616
Practice Address - Country:US
Practice Address - Phone:320-289-8503
Practice Address - Fax:320-289-1797
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106604225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist