Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 18-01063 | KS |
NPI | 1013310010 |
---|---|
Provider Name | Amy Reynolds |
First Address | Salina, KS 67401-4120 |
Second Address | Bel Aire, KS 67226-8817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2014 |
Last Update Date | 03/10/2014 |