Provider Demographics
NPI:1629700059
Name:MARINELLI, KAYLA MARIE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:MARINELLI
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BROOKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2033
Mailing Address - Country:US
Mailing Address - Phone:573-259-7743
Mailing Address - Fax:
Practice Address - Street 1:324 S MASON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8029
Practice Address - Country:US
Practice Address - Phone:573-259-7743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014017951225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics