Healthcare Provider Details

I. General information

NPI: 1588642466
Provider Name (Legal Business Name): JAN LEE LANGLEY OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 S HILLSIDE ST
WICHITA KS
67211-4001
US

IV. Provider business mailing address

7206 E HUNTINGTON ST
WICHITA KS
67206-2049
US

V. Phone/Fax

Practice location:
  • Phone: 316-618-1252
  • Fax:
Mailing address:
  • Phone: 316-680-0820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number17-00518
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: