Healthcare Provider Details

I. General information

NPI: 1083079503
Provider Name (Legal Business Name): TASHAYLA MARKEA OKOT-KOTBER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TASHAYLA MARKEA GARRETT OTR/L

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 N ROCK RD STE 101
WICHITA KS
67226-1341
US

IV. Provider business mailing address

12009 ASH ST APT 24
OVERLAND PARK KS
66209-3106
US

V. Phone/Fax

Practice location:
  • Phone: 316-440-3316
  • Fax:
Mailing address:
  • Phone: 785-727-5674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1703028
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: