Provider Demographics
NPI:1720322100
Name:WORMAN, MARTI S (COTA/L)
Entity Type:Individual
Prefix:
First Name:MARTI
Middle Name:S
Last Name:WORMAN
Suffix:
Gender:F
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 1:843 N WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-1856
Mailing Address - Country:US
Mailing Address - Phone:316-788-9777
Mailing Address - Fax:
Practice Address - Street 1:2020 N TYLER RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4905
Practice Address - Country:US
Practice Address - Phone:316-295-4591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00282224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant