Provider Demographics
NPI:1629215025
Name:LEIS, JANET SUSAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:SUSAN
Last Name:LEIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S FRY ST
Mailing Address - Street 2:
Mailing Address - City:YATES CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:66783-1640
Mailing Address - Country:US
Mailing Address - Phone:620-625-2111
Mailing Address - Fax:620-625-3630
Practice Address - Street 1:801 S FRY ST
Practice Address - Street 2:
Practice Address - City:YATES CENTER
Practice Address - State:KS
Practice Address - Zip Code:66783-1640
Practice Address - Country:US
Practice Address - Phone:620-625-2111
Practice Address - Fax:620-625-3630
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-00186225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist