Healthcare Provider Details

I. General information

NPI: 1730513227
Provider Name (Legal Business Name): KC DEVELOPMENTAL THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3795 W. 95TH ST
OVERLAND PARK KS
66206
US

IV. Provider business mailing address

3795 W. 95TH ST
OVERLAND PARK KS
66206
US

V. Phone/Fax

Practice location:
  • Phone: 913-286-0422
  • Fax: 844-380-0832
Mailing address:
  • Phone: 913-286-0422
  • Fax: 844-380-0832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number17-02461
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2007036385
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2006020242
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2666
License Number StateKS

VIII. Authorized Official

Name: EMILY CHRISTINE TRITZ
Title or Position: CO OWNER/OT
Credential: OTD, OTRIL
Phone: 816-332-6138