Provider Demographics
NPI:1083079503
Name:OKOT-KOTBER, TASHAYLA MARKEA (OTR/L)
Entity Type:Individual
Prefix:
First Name:TASHAYLA
Middle Name:MARKEA
Last Name:OKOT-KOTBER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:TASHAYLA
Other - Middle Name:MARKEA
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:12009 ASH ST APT 24
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3106
Mailing Address - Country:US
Mailing Address - Phone:785-727-5674
Mailing Address - Fax:
Practice Address - Street 1:3500 N ROCK RD STE 101
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1341
Practice Address - Country:US
Practice Address - Phone:316-440-3316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1703028225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics