Healthcare Provider Details

I. General information

NPI: 1154256444
Provider Name (Legal Business Name): LYN BROOKS PETRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8012 STATE LINE RD
PRAIRIE VILLAGE KS
66208-3722
US

IV. Provider business mailing address

12613 SAGAMORE RD
LEAWOOD KS
66209-1325
US

V. Phone/Fax

Practice location:
  • Phone: 913-706-0747
  • Fax:
Mailing address:
  • Phone: 816-560-6192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number17-01224
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: