Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | 17-00941 | KS |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1235690892 |
---|---|
Provider Name | Kristine Marie Price |
First Address | Augusta, KS 67010-2303 |
Second Address | Augusta, KS 67010-2303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2019 |
Last Update Date | 22/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17-00941 | KANSAS OCCUPATIONAL THERAPY LICENSE (01) | KS |