Individual
YEHOSHUA M. OTHNIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3751 W MAIN ST, INDEPENDENCE, KS 67301-8446
(620) 331-1748
Mailing address
PO BOX 688, INDEPENDENCE, KS 67301-0688
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4133
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200435680A
—
KS
01
—
6919008
MEDICARE PTAN
KS
Enumeration date
07/05/2007
Last updated
02/18/2013
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