Provider Demographics
NPI:1134897358
Name:KEIRSEY, KARALINE ALYNN (COTA/L)
Entity type:Individual
Prefix:
First Name:KARALINE
Middle Name:ALYNN
Last Name:KEIRSEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LILLIAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-1578
Mailing Address - Country:US
Mailing Address - Phone:573-625-0915
Mailing Address - Fax:
Practice Address - Street 1:400 WINCHESTER DR
Practice Address - Street 2:
Practice Address - City:BERNIE
Practice Address - State:MO
Practice Address - Zip Code:63822-7500
Practice Address - Country:US
Practice Address - Phone:573-293-6702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019018461224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant