Provider Demographics
NPI:1548572266
Name:HUWYLER, JODY LEE (CO, BOCO)
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:LEE
Last Name:HUWYLER
Suffix:
Gender:F
Credentials:CO, BOCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 N. ANNA ST.
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-2844
Mailing Address - Country:US
Mailing Address - Phone:316-640-0614
Mailing Address - Fax:316-941-3502
Practice Address - Street 1:6114 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-2844
Practice Address - Country:US
Practice Address - Phone:316-640-0614
Practice Address - Fax:316-941-3502
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist