Provider Demographics
NPI:1487925525
Name:DOTY, ANNELISE C (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ANNELISE
Middle Name:C
Last Name:DOTY
Suffix:
Gender:F
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 1:4611 SE PAULEN RD
Mailing Address - Street 2:
Mailing Address - City:BERRYTON
Mailing Address - State:KS
Mailing Address - Zip Code:66409-9235
Mailing Address - Country:US
Mailing Address - Phone:785-220-7740
Mailing Address - Fax:785-841-2262
Practice Address - Street 1:879 E 1259 RD
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-9201
Practice Address - Country:US
Practice Address - Phone:785-331-0667
Practice Address - Fax:785-841-2262
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1700069225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist