MEDICARE: JANET SUSAN LEIS OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	17-00186	KS

General Provider Information

NPI Number	:	1629215025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET SUSAN LEIS OTR/L

Provider Business Mailing Address
First Line	:	801 S FRY ST
Second Line	:
City	:	YATES CENTER
State	:	KS
Zip	:	66783-1640
Country	:	US
Telephone Number	:	620-625-2111
Fax Number	:	620-625-3630

Provider Business Practice Location Address
First Line	:	801 S FRY ST
Second Line	:
City	:	YATES CENTER
State	:	KS
Zip	:	66783-1640
Country	:	US
Telephone Number	:	620-625-2111
Fax Number	:	620-625-3630

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2009
Last Update Date	:	01/07/2009

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