Healthcare Provider Details

I. General information

NPI: 1154688398
Provider Name (Legal Business Name): KRIS M VACEK OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 STATE LINE RD STE. 333
LEAWOOD KS
66206-1960
US

IV. Provider business mailing address

131 W 61ST TER
KANSAS CITY MO
64113-1455
US

V. Phone/Fax

Practice location:
  • Phone: 913-491-9404
  • Fax: 913-754-0365
Mailing address:
  • Phone: 816-405-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number004094
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: