Individual
WILSON KEUNGKHAMPHONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
21513 W 50TH ST, SHAWNEE, KS 66226-9793
(913) 207-9383
Mailing address
21513 W 50TH ST, SHAWNEE, KS 66226-9793
(913) 207-9383
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
18-01030
KS
Other
Enumeration date
03/31/2014
Last updated
03/31/2014
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