=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629715586
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRYSTIN D FARMER OTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2022
-----------------------------------------------------
Last Update Date | 05/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4301 MADISON AVE
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64111-3491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-931-4277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 903 S GORDON ST
-----------------------------------------------------
City | CONCORDIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64020-8304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-924-8175
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------