Provider Demographics
NPI:1629524087
Name:REDD, EMILEE ANNE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:EMILEE
Middle Name:ANNE
Last Name:REDD
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:EMILEE
Other - Middle Name:
Other - Last Name:HARRELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30208 PIKE 235
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63336-2411
Mailing Address - Country:US
Mailing Address - Phone:573-470-7251
Mailing Address - Fax:
Practice Address - Street 1:19538 PIKE 266
Practice Address - Street 2:
Practice Address - City:EDIA
Practice Address - State:MO
Practice Address - Zip Code:63344
Practice Address - Country:US
Practice Address - Phone:573-754-2513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016024810225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist