Provider Demographics
NPI:1609266311
Name:MAHNKEN, KATHYRN R (COTA/L)
Entity type:Individual
Prefix:
First Name:KATHYRN
Middle Name:R
Last Name:MAHNKEN
Suffix:
Gender:X
Credentials:COTA/L
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:R
Other - Last Name:GOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:928 W ROLLINS ST
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-1353
Mailing Address - Country:US
Mailing Address - Phone:660-651-5716
Mailing Address - Fax:
Practice Address - Street 1:844 PASSOVER RD
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-2834
Practice Address - Country:US
Practice Address - Phone:573-348-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013002481224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant