Provider Demographics
NPI:1376767293
Name:MCMAHAN, SHELLY ANN (OT)
Entity Type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:ANN
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 COLLEGE BLVD.
Mailing Address - Street 2:#415
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211
Mailing Address - Country:US
Mailing Address - Phone:913-696-5010
Mailing Address - Fax:913-696-5013
Practice Address - Street 1:5520 COLLEGE BLVD.
Practice Address - Street 2:#415
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211
Practice Address - Country:US
Practice Address - Phone:913-696-5010
Practice Address - Fax:913-696-5013
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-00211225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist