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General NPI Number Information
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NPI Number | 1235656661
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Entity Type | Individual
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Provider Name | JAVIER JIMENEZ
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Gender | Male
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Dates
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Enumeration Date | 08/25/2017
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Last Update Date | 08/25/2017
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Provider Practice Location Address
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Address Line | 622 N EDGEMOOR ST
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City | WICHITA
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State | KS
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Zip | 67208-3602
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Country | US
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Telephone | 316-686-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 2137 S IDA ST
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City | WICHITA
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State | KS
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Zip | 67211-5106
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Country | US
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Telephone | 316-712-1663
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 18-01165
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License Number State | KS
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