Provider Demographics
NPI:1891046280
Name:CHILDERS, DAVID (OT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CHILDERS
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-1930
Mailing Address - Country:US
Mailing Address - Phone:620-431-4151
Mailing Address - Fax:620-432-0028
Practice Address - Street 1:1630 W 2ND ST
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-1930
Practice Address - Country:US
Practice Address - Phone:620-431-4151
Practice Address - Fax:620-432-0028
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-03380225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist