Healthcare Provider Details

I. General information

NPI: 1457606733
Provider Name (Legal Business Name): MARCHALL RENA HAMBRICK C.O.T.A./L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11515 TROOST AVE
KANSAS CITY MO
64131-3769
US

IV. Provider business mailing address

5641 EUCLID AVE
KANSAS CITY MO
64130-3333
US

V. Phone/Fax

Practice location:
  • Phone: 816-943-0101
  • Fax:
Mailing address:
  • Phone: 816-359-1529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2004023159
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number18-00668
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: