Provider Demographics
NPI:1528094919
Name:RYAN, CAROL E (OTR/L)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:E
Last Name:RYAN
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 1:2405 JACOB AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-9677
Mailing Address - Country:US
Mailing Address - Phone:785-843-9125
Mailing Address - Fax:785-843-6973
Practice Address - Street 1:1112 W 6TH ST
Practice Address - Street 2:SUITE 124
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2215
Practice Address - Country:US
Practice Address - Phone:785-843-9125
Practice Address - Fax:785-843-6973
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01291225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS120102Medicare PIN