Provider Demographics
NPI:1790043149
Name:STREET, KATHRYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:STREET
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3042 APPLE BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4447
Mailing Address - Country:US
Mailing Address - Phone:314-610-1694
Mailing Address - Fax:
Practice Address - Street 1:13610 BARRETT OFFICE DR STE 104
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-7818
Practice Address - Country:US
Practice Address - Phone:314-822-5107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010031937225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist