Provider Demographics
NPI:1679631410
Name:SPECKART, KATHY JANE (COTA L)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:JANE
Last Name:SPECKART
Suffix:
Gender:F
Credentials:COTA L
Other - Prefix:MRS
Other - First Name:KATHY
Other - Middle Name:JANE
Other - Last Name:SPECKART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA L
Mailing Address - Street 1:11217 OAK HILL MANOR DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-3120
Mailing Address - Country:US
Mailing Address - Phone:314-298-0391
Mailing Address - Fax:
Practice Address - Street 1:2920 FEE FEE ROAD
Practice Address - Street 2:NNC NATIONAL HEALTHCARE MARYLAND HEIGHTS
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63043
Practice Address - Country:US
Practice Address - Phone:314-291-0121
Practice Address - Fax:314-291-0132
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004380224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant