Provider Demographics
NPI:1083656920
Name:WHEATLAND REHABILITATION LLC
Entity Type:Organization
Organization Name:WHEATLAND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LADESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:316-773-7975
Mailing Address - Street 1:10207 YOSEMITE DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67215-1580
Mailing Address - Country:US
Mailing Address - Phone:316-773-7975
Mailing Address - Fax:316-773-9766
Practice Address - Street 1:1401 CHERRY LN
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3152
Practice Address - Country:US
Practice Address - Phone:316-792-2165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01870225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty