Provider Demographics
NPI:1285780452
Name:ROSS, KARI JILL (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KARI
Middle Name:JILL
Last Name:ROSS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 SAFARI LANE
Mailing Address - Street 2:
Mailing Address - City:STRAFFORD
Mailing Address - State:MO
Mailing Address - Zip Code:65757
Mailing Address - Country:US
Mailing Address - Phone:417-818-7512
Mailing Address - Fax:417-859-0064
Practice Address - Street 1:2553 S COLLINSON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3209
Practice Address - Country:US
Practice Address - Phone:417-881-2085
Practice Address - Fax:417-881-0676
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003414225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO473892412Medicaid