Individual
JAVIER JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
622 N EDGEMOOR ST, WICHITA, KS 67208-3602
(316) 686-5100
Mailing address
2137 S IDA ST, WICHITA, KS 67211-5106
(316) 712-1663
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
18-01165
KS
Other
Enumeration date
08/25/2017
Last updated
08/25/2017
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