Provider Demographics
NPI:1659417517
Name:NIDER, SANDRA MARIE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MARIE
Last Name:NIDER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND
Mailing Address - State:KS
Mailing Address - Zip Code:66549
Mailing Address - Country:US
Mailing Address - Phone:785-457-3561
Mailing Address - Fax:
Practice Address - Street 1:105 N HGWY 99 AND MAIN
Practice Address - Street 2:
Practice Address - City:WESTMORELAND
Practice Address - State:KS
Practice Address - Zip Code:66549
Practice Address - Country:US
Practice Address - Phone:785-457-3817
Practice Address - Fax:785-457-3817
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN075005225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist