Basic Information
| Provider Information | |||||||||
| NPI: | 1932824216 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIEBOLT | ||||||||
| FirstName: | ALLISON | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4643 LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641121120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858065416 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12000 LAMAR AVE | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662092705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136632888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2022 | ||||||||
| LastUpdateDate: | 10/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 17-02804 | KS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.