Provider Demographics
NPI:1801938303
Name:DEEKER, KELLY MAUREEN (OTD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MAUREEN
Last Name:DEEKER
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 LONG BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:CASEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62232-2854
Mailing Address - Country:US
Mailing Address - Phone:618-581-3977
Mailing Address - Fax:
Practice Address - Street 1:16020 SWINGLEY RIDGE RD STE 130
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2085
Practice Address - Country:US
Practice Address - Phone:618-581-3977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006939225X00000X
MO2003023377225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist