Healthcare Provider Details

I. General information

NPI: 1003770488
Provider Name (Legal Business Name): SIOBHAN HEADMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N WOODLAWN BLVD
WICHITA KS
67220-2729
US

IV. Provider business mailing address

1734 N CUSTER ST
WICHITA KS
67203-1709
US

V. Phone/Fax

Practice location:
  • Phone: 316-838-2883
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number159759
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: