Provider Demographics
NPI:1811693518
Name:BERTLING, KACI LYNN
Entity type:Individual
Prefix:
First Name:KACI
Middle Name:LYNN
Last Name:BERTLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-8621
Mailing Address - Country:US
Mailing Address - Phone:620-778-0854
Mailing Address - Fax:
Practice Address - Street 1:12000 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2705
Practice Address - Country:US
Practice Address - Phone:913-663-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant