Healthcare Provider Details

I. General information

NPI: 1861144271
Provider Name (Legal Business Name): KC SHOE STOP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10820 W 64TH ST STE 200
SHAWNEE KS
66203-3571
US

IV. Provider business mailing address

10820 W 64TH ST STE 200
SHAWNEE KS
66203-3571
US

V. Phone/Fax

Practice location:
  • Phone: 913-486-1190
  • Fax: 913-300-9624
Mailing address:
  • Phone: 913-486-1190
  • Fax: 913-300-9624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name: NATASHA COLLETTE BELCHER
Title or Position: OWNER
Credential:
Phone: 913-486-1190