=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093958712
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADAPTIVE LIVING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2009
-----------------------------------------------------
Last Update Date | 12/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2423 W. MAPLE STE B
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-390-0772
-----------------------------------------------------
Fax | 316-462-0508
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2423 W. MAPLE STE B
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-390-0772
-----------------------------------------------------
Fax | 316-462-0508
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SHANA M GATSCHET
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 316-390-0772
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 17-01611
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------