Provider Demographics
NPI:1932824216
Name:DIEBOLT, ALLISON (OTR/L)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:DIEBOLT
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 1:4643 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-1120
Mailing Address - Country:US
Mailing Address - Phone:785-806-5416
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:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-02804225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist