Provider Demographics
NPI:1720795677
Name:STAUBER, KELSEY ALLISON (OTRL)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:ALLISON
Last Name:STAUBER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 STRASSNER DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1872
Mailing Address - Country:US
Mailing Address - Phone:844-502-7996
Mailing Address - Fax:
Practice Address - Street 1:1901 DIVISION ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-5168
Practice Address - Country:US
Practice Address - Phone:479-439-5034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201013100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist