Healthcare Provider Details

I. General information

NPI: 1902092000
Provider Name (Legal Business Name): MOD SOLUTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 WASHINGTON ST
CLYDE KS
66938
US

IV. Provider business mailing address

PO BOX 35
SCOTT CITY KS
67871-0035
US

V. Phone/Fax

Practice location:
  • Phone: 785-738-0321
  • Fax:
Mailing address:
  • Phone: 785-738-0321
  • Fax: 785-738-2028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number17-01970
License Number StateKS

VIII. Authorized Official

Name: CATHLEEN JOYCE KELLY
Title or Position: OWNER
Credential: OTR/L
Phone: 785-738-0321