Provider Demographics
NPI:1912367442
Name:KOTSCHWAR, SHANNA
Entity Type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:
Last Name:KOTSCHWAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 NW 45TH ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-4628
Mailing Address - Country:US
Mailing Address - Phone:816-452-1633
Mailing Address - Fax:816-452-1635
Practice Address - Street 1:851 NW 45TH ST
Practice Address - Street 2:SUITE 209
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-4628
Practice Address - Country:US
Practice Address - Phone:816-452-1633
Practice Address - Fax:816-452-1635
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015028486225100000X
KS11-05144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist