Individual
STACY WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
200 CAMPUS DR, DODGE CITY, KS 67801-2760
(620) 225-1928
(620) 408-9058
Mailing address
200 CAMPUS DR, DODGE CITY, KS 67801-2760
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
18-01135
KS
Other
Enumeration date
09/20/2015
Last updated
09/20/2015
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