Provider Demographics
NPI:1508286782
Name:FOSTER, JERRI JANETT (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:JERRI
Middle Name:JANETT
Last Name:FOSTER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:JERRI
Other - Middle Name:JANETT
Other - Last Name:LYDDANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:814 E 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-4342
Mailing Address - Country:US
Mailing Address - Phone:620-663-1189
Mailing Address - Fax:
Practice Address - Street 1:814 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-4342
Practice Address - Country:US
Practice Address - Phone:620-663-1189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00997224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant