Provider Demographics
NPI:1649976234
Name:FLYNN, KYLEE NICOLE (OTR/L)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:NICOLE
Last Name:FLYNN
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 1:3101 SUN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-3050
Mailing Address - Country:US
Mailing Address - Phone:417-499-6739
Mailing Address - Fax:
Practice Address - Street 1:2000 ELM ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-1750
Practice Address - Country:US
Practice Address - Phone:636-443-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023002815225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist