MEDICARE: BROOKE MCKINLEY LACHENMAYR

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	224Z00000X	Occupational Therapy Assistant	18-01747	KS

General Provider Information

NPI Number	:	1992444525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE MCKINLEY LACHENMAYR

Provider Business Mailing Address
First Line	:	5903 N WOODLAWN ST
Second Line	:
City	:	KECHI
State	:	KS
Zip	:	67067-9062
Country	:	US
Telephone Number	:	316-285-3814
Fax Number	:

Provider Business Practice Location Address
First Line	:	5903 N WOODLAWN ST
Second Line	:
City	:	KECHI
State	:	KS
Zip	:	67067-9062
Country	:	US
Telephone Number	:	316-285-3814
Fax Number	:

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

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	06/01/2022

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