Provider Demographics
NPI:1043756463
Name:OPAT, KERRYN ELIZABETH (MED, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KERRYN
Middle Name:ELIZABETH
Last Name:OPAT
Suffix:
Gender:F
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-3847
Mailing Address - Country:US
Mailing Address - Phone:620-242-0584
Mailing Address - Fax:620-242-0515
Practice Address - Street 1:1600 E EUCLID ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-3847
Practice Address - Country:US
Practice Address - Phone:620-242-0584
Practice Address - Fax:620-242-0515
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-008992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer