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General NPI Number Information
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NPI Number | 1871376350
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Entity Type | Individual
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Provider Name | MICHAEL TOREY SHACKELFORD OTR/L
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Gender | Male
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 9920 E HARRY ST
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City | WICHITA
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State | KS
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Zip | 67207-5008
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Country | US
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Telephone | 316-265-4295
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Fax |
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Provider Business Mailing Address
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Address Line | 25100 W INDIAN RIDGE CT
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City | ANDALE
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State | KS
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Zip | 67001-9741
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Country | US
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Telephone | 316-617-0660
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 1701301
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License Number State | KS
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