Provider Demographics
NPI:1700498581
Name:PRITCHARD, GWEN (OT)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:PRITCHARD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13241 SW 80 ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67112-8316
Mailing Address - Country:US
Mailing Address - Phone:620-914-1200
Mailing Address - Fax:
Practice Address - Street 1:1020 MAIN ST
Practice Address - Street 2:
Practice Address - City:KIOWA
Practice Address - State:KS
Practice Address - Zip Code:67070-1421
Practice Address - Country:US
Practice Address - Phone:620-845-4117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1701877225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist