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General NPI Number Information
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NPI Number | 1154917888
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Entity Type | Individual
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Provider Name | KAHABI MPEMBA DEREFA
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Gender | Female
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Dates
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Enumeration Date | 12/16/2020
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 2118 N TYLER RD STE 100 BLDG B
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City | WICHITA
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State | KS
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Zip | 67212-4912
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Country | US
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Telephone | 469-587-9541
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Fax |
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Provider Business Mailing Address
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Address Line | 7272 E 37TH ST N APT 715
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City | WICHITA
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State | KS
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Zip | 67226-3215
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Country | US
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Telephone |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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