Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 2015036501 | MO |
NPI | 1700301264 |
---|---|
Provider Name | Mrs. Kinsey Ann Maddox |
First Address | Lawrence, KS 66049-4706 |
Second Address | Lees Summit, MO 64063-2404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2017 |
Last Update Date | 06/08/2017 |