Provider Demographics
NPI:1669962551
Name:KROUTIL, KATHLEEN NOELL (OTR/L)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:NOELL
Last Name:KROUTIL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:NOELL
Other - Last Name:BODENHAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:617 E EDGEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-3636
Mailing Address - Country:US
Mailing Address - Phone:417-818-9039
Mailing Address - Fax:
Practice Address - Street 1:4586 S 116TH RD
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-8547
Practice Address - Country:US
Practice Address - Phone:417-326-2466
Practice Address - Fax:417-326-7739
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018014372225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty