Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 18-01141 | KS |
NPI | 1013436914 |
---|---|
Provider Name | Lisa Diane Shay |
First Address | Overland Park, KS 66204-3017 |
Second Address | Overland Park, KS 66204-3017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2017 |
Last Update Date | 12/09/2017 |