Healthcare Provider Details

I. General information

NPI: 1306645825
Provider Name (Legal Business Name): BRANDON JAMES ZUKOVICH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2025
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 W 74TH ST
MERRIAM KS
66204-4004
US

IV. Provider business mailing address

2221 W 39TH AVE APT 2E
KANSAS CITY KS
66103-2951
US

V. Phone/Fax

Practice location:
  • Phone: 913-676-2000
  • Fax:
Mailing address:
  • Phone: 316-200-3741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-04314
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: