Provider Demographics
NPI:1245935527
Name:BECK, KATHLEEN DOLORES (OTR/L)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:DOLORES
Last Name:BECK
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 1:713 SCHUMATE CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-0515
Mailing Address - Country:US
Mailing Address - Phone:537-291-3353
Mailing Address - Fax:
Practice Address - Street 1:1720 VIETH DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-2056
Practice Address - Country:US
Practice Address - Phone:573-635-6193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012026724225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist