MEDICARE: DEBORA FARNAM

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	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1700541	OTHER	MO	LICENSE#

General Provider Information

NPI Number	:	1811013725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORA FARNAM

Provider Business Mailing Address
First Line	:	100 E 66TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64113-2323
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 NW SAINT MARY DR STE 102
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2539
Country	:	US
Telephone Number	:	816-229-6622
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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