Provider Demographics
NPI:1447651617
Name:EIMER, KELLI (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:
Last Name:EIMER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:A
Other - Last Name:RAKERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PRE-AUTHORIZATION HA
Mailing Address - Street 1:634 N MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-3746
Mailing Address - Country:US
Mailing Address - Phone:618-690-0068
Mailing Address - Fax:888-452-2930
Practice Address - Street 1:634 N MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3746
Practice Address - Country:US
Practice Address - Phone:618-690-0068
Practice Address - Fax:888-452-2930
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056005227225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics