Provider Demographics
NPI:1275321382
Name:DUTTON, KELSEY MICHELLE (COTA/L)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:MICHELLE
Last Name:DUTTON
Suffix:
Gender:
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 N NEW BALLAS RD STE 211
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6842
Mailing Address - Country:US
Mailing Address - Phone:314-227-2124
Mailing Address - Fax:
Practice Address - Street 1:456 N NEW BALLAS RD STE 211
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6842
Practice Address - Country:US
Practice Address - Phone:314-227-2124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025005958224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant