Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 079430 | IA |
Y | 225X00000X | Occupational Therapist | 2021011699 | MO |
N | 225XP0200X | Occupational Therapist - Pediatrics | 079430 | IA |
NPI | 1063885507 |
---|---|
Provider Name | Katlyn Denae Bokhoven |
First Address | Independence, MO 64055 |
Second Address | Kansas City, MO 64114-4359 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2015 |
Last Update Date | 21/05/2021 |