Provider Demographics
NPI:1578726436
Name:TRECEK, MARLA DANEAN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:DANEAN
Last Name:TRECEK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:MARLA
Other - Middle Name:DANEAN
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:639 S MAIZE COURT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209
Mailing Address - Country:US
Mailing Address - Phone:316-425-5600
Mailing Address - Fax:
Practice Address - Street 1:639 S MAIZE RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-1334
Practice Address - Country:US
Practice Address - Phone:316-425-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01310225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist