Provider Demographics
NPI:1295007946
Name:HIGGS, KATHLEEN AMBER (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:AMBER
Last Name:HIGGS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:AMBER
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:622 N EDGEMOOR ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3602
Mailing Address - Country:US
Mailing Address - Phone:316-686-5100
Mailing Address - Fax:
Practice Address - Street 1:622 N EDGEMOOR ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3602
Practice Address - Country:US
Practice Address - Phone:316-686-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-02671225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist