Healthcare Provider Details

I. General information

NPI: 1548512957
Provider Name (Legal Business Name): JILL KATHRYN ROBISON OTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7819 CONSER PL
OVERLAND PARK KS
66204
US

IV. Provider business mailing address

3965 W. 83RD STREET SUITE 233
PRAIRIE VILLAGE KS
66208
US

V. Phone/Fax

Practice location:
  • Phone: 913-789-9170
  • Fax:
Mailing address:
  • Phone: 913-789-9170
  • Fax: 913-789-9170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number18-00257
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: