Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 4594295371 | KS |
NPI | 1063189769 |
---|---|
Provider Name | Mrs. Kelli Anne Otsuka |
First Address | Wichita, KS 67205-2063 |
Second Address | Wichita, KS 67205-2063 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2021 |
Last Update Date | 30/08/2021 |