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General NPI Number Information
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NPI Number | 1770063372
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Entity Type | Individual
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Provider Name | TARA JANAE LITZEL OT/L, COTA/L
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Gender | Female
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Dates
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Enumeration Date | 08/14/2018
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Last Update Date | 03/02/2021
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Provider Practice Location Address
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Address Line | 629 S PLUMMER AVE
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City | CHANUTE
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State | KS
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Zip | 66720-1928
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Country | US
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Telephone | 620-432-5379
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Fax |
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Provider Business Mailing Address
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Address Line | 422 S KANSAS AVE
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City | CHANUTE
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State | KS
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Zip | 66720-2107
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Country | US
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Telephone | 620-212-1825
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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 | 18-01341
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | T-05144
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 17-03599
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License Number State | KS
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