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General NPI Number Information
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NPI Number | 1093132664
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Entity Type | Individual
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Provider Name | ALYSE BARTHOLOMEW OTR
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Gender | Female
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Dates
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Enumeration Date | 03/21/2014
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Last Update Date | 03/21/2014
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Provider Practice Location Address
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Address Line | 242 CARROLL ST
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City | SAINT PAUL
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State | KS
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Zip | 66771-4044
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Country | US
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Telephone | 620-449-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 709 E HILL ST
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City | INDEPENDENCE
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State | KS
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Zip | 67301-4338
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Country | US
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Telephone | 207-939-8120
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | T03572
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License Number State | KS
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