Provider Demographics
NPI:1477988111
Name:DUNLAP, KETURAH MARY KATHERINE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:KETURAH
Middle Name:MARY KATHERINE
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3923 LLOYD ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66103-2828
Mailing Address - Country:US
Mailing Address - Phone:913-660-4899
Mailing Address - Fax:
Practice Address - Street 1:3923 LLOYD ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66103-2828
Practice Address - Country:US
Practice Address - Phone:913-660-4899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008028149171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor