Provider Demographics
NPI:1407070444
Name:SHIFRIN, KATHERINE DEANNE
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:DEANNE
Last Name:SHIFRIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KATIE
Other - Middle Name:DEANNE
Other - Last Name:SHIFRIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:800 S ABILENE AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67147-2155
Mailing Address - Country:US
Mailing Address - Phone:316-260-1287
Mailing Address - Fax:
Practice Address - Street 1:622 N EDGEMOOR ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3602
Practice Address - Country:US
Practice Address - Phone:316-686-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-02326225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist