Healthcare Provider Details

I. General information

NPI: 1700688470
Provider Name (Legal Business Name): JENA MARTIN OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12728 STATE LINE RD
LEAWOOD KS
66209-1619
US

IV. Provider business mailing address

1815 SOLAR CIR
SMITHVILLE MO
64089-8977
US

V. Phone/Fax

Practice location:
  • Phone: 816-666-1187
  • Fax:
Mailing address:
  • Phone: 816-666-1187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberKS170401
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: