Provider Demographics
NPI:1215149109
Name:GRAHAM, SANDRA (OTR)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 N OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-2106
Mailing Address - Country:US
Mailing Address - Phone:316-558-3410
Mailing Address - Fax:316-267-5444
Practice Address - Street 1:2258 N LAKEWAY CIR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1082
Practice Address - Country:US
Practice Address - Phone:316-558-3410
Practice Address - Fax:316-267-5444
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1701942225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist