Provider Demographics
NPI:1568495117
Name:WICHITA OCCUPATIONAL REHAB & SOLUTIONS PA
Entity Type:Organization
Organization Name:WICHITA OCCUPATIONAL REHAB & SOLUTIONS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MA
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAUNZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-558-8272
Mailing Address - Street 1:7111 E 21ST ST N
Mailing Address - Street 2:SUITE E
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1090
Mailing Address - Country:US
Mailing Address - Phone:316-558-8272
Mailing Address - Fax:316-558-5285
Practice Address - Street 1:7111 E 21ST ST N
Practice Address - Street 2:SUITE E
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1090
Practice Address - Country:US
Practice Address - Phone:316-558-8272
Practice Address - Fax:316-558-5285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0424611208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS111239OtherBLUE SHIELD