Individual
JENIFER MANDEVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2114 N 127TH ST E, WICHITA, KS 67206-3003
(316) 500-8800
Mailing address
2114 N 127TH ST E, WICHITA, KS 67206-3003
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
18-00199
KS
Other
Enumeration date
04/17/2014
Last updated
01/14/2015
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