Provider Demographics
NPI:1891792685
Name:AHLSTEDT, CHARISSA ANN (OT)
Entity Type:Individual
Prefix:MRS
First Name:CHARISSA
Middle Name:ANN
Last Name:AHLSTEDT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CHARISSA
Other - Middle Name:ANN
Other - Last Name:ORCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2342 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:LINDSBORG
Mailing Address - State:KS
Mailing Address - Zip Code:67456-5071
Mailing Address - Country:US
Mailing Address - Phone:785-227-8828
Mailing Address - Fax:
Practice Address - Street 1:1015 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-5735
Practice Address - Country:US
Practice Address - Phone:620-241-1825
Practice Address - Fax:620-241-7135
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1701788225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS013626OtherBCBS OF KS