Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 17-00972 | KS |
NPI | 1174918676 |
---|---|
Provider Name | Susan Verstraete |
First Address | Shawnee, KS 66216-1357 |
Second Address | Prairie Village, KS 66208-3000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2015 |
Last Update Date | 01/04/2015 |