Provider Demographics
NPI:1326192550
Name:JORDAN, LYSBETH JANE (MOT OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LYSBETH
Middle Name:JANE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MOT OTR/L
Other - Prefix:MISS
Other - First Name:LYSBETH
Other - Middle Name:JANE
Other - Last Name:KLEEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT OTR/L
Mailing Address - Street 1:3014 EDMOND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64501-3312
Mailing Address - Country:US
Mailing Address - Phone:816-590-3213
Mailing Address - Fax:816-232-8777
Practice Address - Street 1:3014 EDMOND ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64501-3312
Practice Address - Country:US
Practice Address - Phone:816-383-2772
Practice Address - Fax:816-232-8777
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005493225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics