Healthcare Provider Details

I. General information

NPI: 1912956079
Provider Name (Legal Business Name): SERC HAND REHABILITATION SOUTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 W 110TH ST
OVERLAND PARK KS
66210-2339
US

IV. Provider business mailing address

7211 W 110TH ST
OVERLAND PARK KS
66210-2339
US

V. Phone/Fax

Practice location:
  • Phone: 913-451-7372
  • Fax: 913-451-7375
Mailing address:
  • Phone: 913-451-7372
  • Fax: 913-451-7375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number17-00153
License Number StateKS

VIII. Authorized Official

Name: LAURIE A REED
Title or Position: CLINIC DIRECTOR
Credential: OTR/L, CHT
Phone: 913-451-7372