Healthcare Provider Details

I. General information

NPI: 1962032219
Provider Name (Legal Business Name): HANNA CHURCHILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15044 S BLACKBOB RD
OLATHE KS
66062-2663
US

IV. Provider business mailing address

7724 REEDS RD
PRAIRIE VILLAGE KS
66208-4759
US

V. Phone/Fax

Practice location:
  • Phone: 913-449-9696
  • Fax:
Mailing address:
  • Phone: 314-609-8211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-04391
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: