=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568495117
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WICHITA OCCUPATIONAL REHAB & SOLUTIONS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2006
-----------------------------------------------------
Last Update Date | 08/30/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7111 E 21ST ST N SUITE E
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67206-1090
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-558-8272
-----------------------------------------------------
Fax | 316-558-5285
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7111 E 21ST ST N SUITE E
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67206-1090
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-558-8272
-----------------------------------------------------
Fax | 316-558-5285
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MA
-----------------------------------------------------
Name | JOYCE D MAUNZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 316-558-8272
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 0424611
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------