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General NPI Number Information
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NPI Number | 1700301264
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Entity Type | Individual
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Provider Name | KINSEY ANN MADDOX OT
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Gender | Female
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Dates
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Enumeration Date | 08/06/2017
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Last Update Date | 08/06/2017
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Provider Practice Location Address
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Address Line | 204 NE CHIPMAN RD
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City | LEES SUMMIT
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State | MO
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Zip | 64063-2404
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Country | US
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Telephone | 816-682-5736
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Fax |
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Provider Business Mailing Address
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Address Line | 905 EASY ST
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City | LAWRENCE
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State | KS
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Zip | 66049-4706
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Country | US
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Telephone | 580-650-9197
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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 | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | 2015036501
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License Number State | MO
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