Provider Demographics
NPI:1174117113
Name:WILLS, JANDY SUZANNE (OCCUPATIONAL THERAPI)
Entity type:Individual
Prefix:
First Name:JANDY
Middle Name:SUZANNE
Last Name:WILLS
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3542 SW RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-1701
Mailing Address - Country:US
Mailing Address - Phone:913-522-1252
Mailing Address - Fax:
Practice Address - Street 1:3542 SW RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-1701
Practice Address - Country:US
Practice Address - Phone:913-522-1252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-20
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-00791225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology