Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 17-00621 | KS |
NPI | 1275673261 |
---|---|
Provider Name | Ms. Lesa Lea Beauchamp |
First Address | Wichita, KS 67235-1319 |
Second Address | Wichita, KS 67212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 29/01/2018 |