Provider Demographics
NPI:1790092336
Name:MCINTYRE, STEVEN RUSSELL (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:RUSSELL
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:COTA/L
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:620-632-4580
Practice Address - Street 1:1217 S 15TH ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-5125
Practice Address - Country:US
Practice Address - Phone:620-421-2431
Practice Address - Fax:620-423-0185
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1800429224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant