MEDICARE: MRS. SUSAN E EDGINGTON OT

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	17-01607	KS

General Provider Information

NPI Number	:	1699741660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN E EDGINGTON OT

Provider Business Mailing Address
First Line	:	2810 RIVER PARK DR
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67203-2075
Country	:	US
Telephone Number	:	316-832-1891
Fax Number	:

Provider Business Practice Location Address
First Line	:	728 N EMPORIA ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67214-3708
Country	:	US
Telephone Number	:	316-263-1952
Fax Number	:	316-263-4384

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	07/08/2007

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