Provider Demographics
NPI:1518160399
Name:MCINTYRE, MARIE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:MCINTYRE
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 1:210 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MC CUNE
Mailing Address - State:KS
Mailing Address - Zip Code:66753-4043
Mailing Address - Country:US
Mailing Address - Phone:620-632-4580
Mailing Address - Fax:
Practice Address - Street 1:206 S DITTMAN ST
Practice Address - Street 2:
Practice Address - City:FRONTENAC
Practice Address - State:KS
Practice Address - Zip Code:66763-2253
Practice Address - Country:US
Practice Address - Phone:615-896-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00360224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant