Provider Demographics
NPI:1861077455
Name:KAYS, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:KAYS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3422
Mailing Address - Country:US
Mailing Address - Phone:816-506-2699
Mailing Address - Fax:
Practice Address - Street 1:6814 SOBBIE RD
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64068-9555
Practice Address - Country:US
Practice Address - Phone:816-781-5277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012018429224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant