Provider Demographics
NPI:1356781280
Name:EBBERTS, HAZEL NMI (OTR)
Entity type:Individual
Prefix:
First Name:HAZEL
Middle Name:NMI
Last Name:EBBERTS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 S SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-3828
Mailing Address - Country:US
Mailing Address - Phone:620-365-9359
Mailing Address - Fax:620-365-1199
Practice Address - Street 1:101 S 1ST ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-3505
Practice Address - Country:US
Practice Address - Phone:620-365-1062
Practice Address - Fax:620-365-1199
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01192225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist