Healthcare Provider Details

I. General information

NPI: 1790229201
Provider Name (Legal Business Name): BECKY CRAIG OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 E 29TH ST N
WICHITA KS
67226-2169
US

IV. Provider business mailing address

1450 S LOOKOUT DR
WICHITA KS
67230-9522
US

V. Phone/Fax

Practice location:
  • Phone: 316-634-8710
  • Fax: 316-634-8891
Mailing address:
  • Phone: 704-824-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2064
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number11368
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-04268
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: