Provider Demographics
NPI:1275841819
Name:WOODROOF, MANDY A
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:A
Last Name:WOODROOF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOPE
Mailing Address - State:KS
Mailing Address - Zip Code:67108-9408
Mailing Address - Country:US
Mailing Address - Phone:316-667-2431
Mailing Address - Fax:
Practice Address - Street 1:704 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOPE
Practice Address - State:KS
Practice Address - Zip Code:67108-9408
Practice Address - Country:US
Practice Address - Phone:316-667-2431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-02656224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant