MEDICARE: MRS. MELINDA BETH SHELLENBERGER OTR/L

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	225XP0200X	Pediatric Occupational Therapist	1701909	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	120069	OTHER	KS	BCBS PROVIDER NUMBER
2	9452	OTHER	KS	PREFERRED HEALTH SYSTEMS

General Provider Information

NPI Number	:	1215951405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELINDA BETH SHELLENBERGER OTR/L

Provider Business Mailing Address
First Line	:	1811 E BEAUMONT ST
Second Line	:
City	:	PARK CITY
State	:	KS
Zip	:	67219-2420
Country	:	US
Telephone Number	:	316-260-2251
Fax Number	:	316-744-3152

Provider Business Practice Location Address
First Line	:	1811 E BEAUMONT ST
Second Line	:
City	:	PARK CITY
State	:	KS
Zip	:	67219-2420
Country	:	US
Telephone Number	:	316-260-2251
Fax Number	:	316-744-3152

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	05/28/2008

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