Healthcare Provider Details

I. General information

NPI: 1124587704
Provider Name (Legal Business Name): REHAB ALSADEQ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16201 WEDD ST
OVERLAND PARK KS
66085-7857
US

IV. Provider business mailing address

16201 WEDD ST
OVERLAND PARK KS
66085-7857
US

V. Phone/Fax

Practice location:
  • Phone: 913-306-4974
  • Fax:
Mailing address:
  • Phone: 913-306-4974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number208
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2018035806
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: