Provider Demographics
NPI:1770108490
Name:LASSMAN, KENNETH EUGENE (OTR/L)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:EUGENE
Last Name:LASSMAN
Suffix:
Gender:M
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 1:1357 N 1000 RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-9608
Mailing Address - Country:US
Mailing Address - Phone:785-843-0253
Mailing Address - Fax:
Practice Address - Street 1:501 SW JACKSON ST STE 100
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66603-9701
Practice Address - Country:US
Practice Address - Phone:785-233-4572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS17-0653OtherKANSAS STATE BOARD OF HEALING ARTS