Provider Demographics
NPI:1588631139
Name:SUBLETTE, JEAN B (OTRL CHT)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:B
Last Name:SUBLETTE
Suffix:
Gender:F
Credentials:OTRL CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10016 NW AMBASSADOR DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64153
Mailing Address - Country:US
Mailing Address - Phone:816-891-7162
Mailing Address - Fax:816-891-6704
Practice Address - Street 1:10016 NW AMBASSADOR DT
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153
Practice Address - Country:US
Practice Address - Phone:816-891-7162
Practice Address - Fax:816-891-6704
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000780225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO20067046OtherBCBS
MO2666642Medicare ID - Type Unspecified