Healthcare Provider Details

I. General information

NPI: 1215951405
Provider Name (Legal Business Name): MELINDA BETH SHELLENBERGER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 E BEAUMONT ST
PARK CITY KS
67219-2420
US

IV. Provider business mailing address

1811 E BEAUMONT ST
PARK CITY KS
67219-2420
US

V. Phone/Fax

Practice location:
  • Phone: 316-260-2251
  • Fax: 316-744-3152
Mailing address:
  • Phone: 316-260-2251
  • Fax: 316-744-3152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1701909
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: