Provider Demographics
NPI:1588098412
Name:SPROUT PEDIATRIC OCCUPATIONAL THERAPY, LLC
Entity type:Organization
Organization Name:SPROUT PEDIATRIC OCCUPATIONAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WENDT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L,BCP
Authorized Official - Phone:316-440-3316
Mailing Address - Street 1:PO BOX 17053
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-0053
Mailing Address - Country:US
Mailing Address - Phone:316-944-3940
Mailing Address - Fax:316-946-0694
Practice Address - Street 1:3500 N ROCK RD, BLDG 2200, STE 101
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1701783225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty