Basic Information
| Provider Information | |||||||||
| NPI: | 1053517425 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PUTNAM | ||||||||
| FirstName: | PATRICIA | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 508 MAIN ST | ||||||||
| Address2: | BOX 258 | ||||||||
| City: | PERRY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855975577 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1501 INVERNESS DR | ||||||||
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| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660471870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858388000 | ||||||||
| FaxNumber: | 7858388972 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 04/03/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 18-00135 | KS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.