Provider Demographics
NPI:1831478635
Name:SHIDELER, KRISTEN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:SHIDELER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:4921 E 21ST ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-1602
Mailing Address - Country:US
Mailing Address - Phone:316-681-3204
Mailing Address - Fax:316-681-0541
Practice Address - Street 1:3500 N ROCK RD STE 101
Practice Address - Street 2:BUILDING 2200
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1341
Practice Address - Country:US
Practice Address - Phone:316-440-3316
Practice Address - Fax:888-965-6885
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2019-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211163224Z00000X
KS17-02953225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant