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General NPI Number Information
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NPI Number | 1629215736
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Entity Type | Individual
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Provider Name | DEENA K LIGHTY OTA
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Gender | Female
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Dates
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Enumeration Date | 01/12/2009
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Last Update Date | 01/12/2009
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Provider Practice Location Address
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Address Line | 100 W 16TH ST
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City | EUREKA
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State | KS
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Zip | 67045-1064
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Country | US
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Telephone | 615-896-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 3109 STEVEN ST
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City | AUGUSTA
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State | KS
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Zip | 67010-2506
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Country | US
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Telephone | 615-896-6400
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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 | 1800056
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License Number State | KS
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