Individual
MS. ANGELA JOY ENTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
622 N EDGEMOOR ST, WICHITA, KS 67208-3602
(316) 686-5100
Mailing address
2801 N ROCK RD APT 1202, WICHITA, KS 67226-1184
(316) 208-9415
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
18-01147
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891742573
—
KS
Enumeration date
08/25/2017
Last updated
08/25/2017
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