Provider Demographics
NPI:1093320475
Name:MASSEY, SANDRA LYNN (OTR/L)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:MASSEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LYNN
Other - Last Name:WOYDZIAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1859 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3413
Mailing Address - Country:US
Mailing Address - Phone:316-854-2539
Mailing Address - Fax:
Practice Address - Street 1:6652 N SCOTTSVILLE ST
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:KS
Practice Address - Zip Code:67219-1525
Practice Address - Country:US
Practice Address - Phone:316-706-3618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-22352083X0100X
KS17-022352083X0100X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine