Provider Demographics
NPI:1194160671
Name:HERBEL, KRISTY LYNN (OTR)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:HERBEL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:LYNN
Other - Last Name:GADDIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 N ROCK RD
Mailing Address - Street 2:BLDG 2200, SUITE 101
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1341
Mailing Address - Country:US
Mailing Address - Phone:316-440-3316
Mailing Address - Fax:
Practice Address - Street 1:3500 N ROCK RD
Practice Address - Street 2:BLDG 2200, SUITE 101
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226
Practice Address - Country:US
Practice Address - Phone:316-440-3316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01122225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS17-01122Other1194160671