MEDICARE: MINDI M SHUPE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1164244398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINDI M SHUPE

Provider Business Mailing Address
First Line	:	7150 N FIELDSTONE CT
Second Line	:
City	:	PARKVILLE
State	:	MO
Zip	:	64152-4923
Country	:	US
Telephone Number	:	913-486-8807
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 E 18TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64127-2602
Country	:	US
Telephone Number	:	816-241-3994
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	10/29/2024

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Directions to “ MINDI M SHUPE ” Practice Location

Language	Start Address	Practice Location

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