Provider Demographics
NPI:1902468929
Name:MERRELL, KAYCEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAYCEE
Middle Name:
Last Name:MERRELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KAYCEE
Other - Middle Name:LYNN
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5400 BRODIE LN STE 295
Practice Address - Street 2:
Practice Address - City:SUNSET VALLEY
Practice Address - State:TX
Practice Address - Zip Code:78745-2525
Practice Address - Country:US
Practice Address - Phone:512-676-3949
Practice Address - Fax:512-256-7751
Is Sole Proprietor?:No
Enumeration Date:2019-06-29
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119028225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist