Individual
TIMOTHY HOWARD KOONTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR-L
Contact information
Practice address
8700 E 29TH ST N, WICHITA, KS 67226-2169
(316) 634-8753
Mailing address
1528 E 39TH ST N, WICHITA, KS 67219-3302
(316) 838-0991
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
17-02409
KS
Other
Enumeration date
07/03/2007
Last updated
07/08/2007
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