Provider Demographics
NPI:1881973410
Name:VANVOORST, KYRI (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:KYRI
Middle Name:
Last Name:VANVOORST
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:KYRI
Other - Middle Name:
Other - Last Name:LANCASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:28425 N BLACK CANYON HWY
Mailing Address - Street 2:#3081
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-7601
Mailing Address - Country:US
Mailing Address - Phone:712-540-8633
Mailing Address - Fax:
Practice Address - Street 1:14775 W YORKSHIRE DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7224
Practice Address - Country:US
Practice Address - Phone:623-377-9698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-13
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4833225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist