Healthcare Provider Details

I. General information

NPI: 1174486054
Provider Name (Legal Business Name): TALLGRASS PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 COLLEGE AVE STE B100
MANHATTAN KS
66502-2943
US

IV. Provider business mailing address

1133 COLLEGE AVE STE B100
MANHATTAN KS
66502-2943
US

V. Phone/Fax

Practice location:
  • Phone: 785-231-7796
  • Fax:
Mailing address:
  • Phone: 785-231-7796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KATHARINE LACEY BEAVER
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 785-231-7796