Healthcare Provider Details

I. General information

NPI: 1669336632
Provider Name (Legal Business Name): JENIFER CALLAWAY OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

423 N MCLEAN BLVD
WICHITA KS
67203-5964
US

IV. Provider business mailing address

423 N MCLEAN BLVD
WICHITA KS
67203-5964
US

V. Phone/Fax

Practice location:
  • Phone: 316-618-1252
  • Fax: 316-869-2277
Mailing address:
  • Phone: 316-618-1252
  • Fax: 316-869-2277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-01876
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: