Provider Demographics
NPI:1043432636
Name:SKINNER, SALLY AMANDA (OTR)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:AMANDA
Last Name:SKINNER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 S CLEARWATER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5237
Mailing Address - Country:US
Mailing Address - Phone:330-775-3120
Mailing Address - Fax:
Practice Address - Street 1:101 N PINE ST
Practice Address - Street 2:
Practice Address - City:GARNETT
Practice Address - State:KS
Practice Address - Zip Code:66032-1134
Practice Address - Country:US
Practice Address - Phone:785-448-2434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03450225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist