Healthcare Provider Details

I. General information

NPI: 1437027331
Provider Name (Legal Business Name): RYLIE BLAINE SHOOP OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/02/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 W 1ST ST
COFFEYVILLE KS
67337-2441
US

IV. Provider business mailing address

4721 DARTMOUTH DR
BARTLESVILLE OK
74006-8611
US

V. Phone/Fax

Practice location:
  • Phone: 620-251-3705
  • Fax:
Mailing address:
  • Phone: 620-205-8535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6523
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-04607
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: