MEDICARE: CANCER REHABILITATION SPECIALISTS LYMPHATIC AND VENOUS DISORDERS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1700887056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANCER REHABILITATION SPECIALISTS LYMPHATIC AND VENOUS DISORDERS INC

Provider Business Mailing Address
First Line	:	8900 STATE LINE RD
Second Line	:	STE 333
City	:	LEAWOOD
State	:	KS
Zip	:	66206-1941
Country	:	US
Telephone Number	:	913-491-9404
Fax Number	:	913-754-0365

Provider Business Practice Location Address
First Line	:	8900 STATE LINE RD
Second Line	:	STE 333
City	:	LEAWOOD
State	:	KS
Zip	:	66206-1941
Country	:	US
Telephone Number	:	913-491-9404
Fax Number	:	913-754-0365

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. ELIZABETH A GREGORY
Credential	:
Telephone Number	:	913-491-9404

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	03/19/2013

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