Healthcare Provider Details

I. General information

NPI: 1093320475
Provider Name (Legal Business Name): SANDRA LYNN MASSEY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA LYNN WOYDZIAK OTR/L

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6652 N SCOTTSVILLE ST
PARK CITY KS
67219-1525
US

IV. Provider business mailing address

1859 N WEBB RD
WICHITA KS
67206-3413
US

V. Phone/Fax

Practice location:
  • Phone: 316-706-3618
  • Fax:
Mailing address:
  • Phone: 316-854-2539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number17-2235
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number17-02235
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-02235
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: