Provider Demographics
NPI:1326391616
Name:CORDEL, JENNA MARIE (OT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:CORDEL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:SCHUELKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:200 W DOUGLAS AVE
Mailing Address - Street 2:STE 1040
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3013
Mailing Address - Country:US
Mailing Address - Phone:316-263-0003
Mailing Address - Fax:316-263-1241
Practice Address - Street 1:712 1ST TER
Practice Address - Street 2:STE 103
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-1735
Practice Address - Country:US
Practice Address - Phone:913-727-2022
Practice Address - Fax:913-727-2033
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-02817225X00000X
MO2012022632225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist