Provider Demographics
NPI:1114123262
Name:SCHWATKEN, KELLY LYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYN
Last Name:SCHWATKEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24795 OLD KC RD
Mailing Address - Street 2:
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-5416
Mailing Address - Country:US
Mailing Address - Phone:913-294-4343
Mailing Address - Fax:913-294-4485
Practice Address - Street 1:501 S HOSPITAL DR
Practice Address - Street 2:SUITE 400
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-2103
Practice Address - Country:US
Practice Address - Phone:913-294-4343
Practice Address - Fax:913-294-4485
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007013773225X00000X
KS17-02442225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist