Provider Demographics
NPI:1679881528
Name:BEISEL, ANN J (COTA)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:J
Last Name:BEISEL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 N RECA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-1433
Mailing Address - Country:US
Mailing Address - Phone:316-214-0287
Mailing Address - Fax:316-284-9859
Practice Address - Street 1:1200 E 7TH ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-2820
Practice Address - Country:US
Practice Address - Phone:316-284-5981
Practice Address - Fax:316-284-9859
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00266224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant