Healthcare Provider Details

I. General information

NPI: 1902727316
Provider Name (Legal Business Name): TAYLOR BROOKE SULLIVAN OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8340 MISSION RD
PRAIRIE VILLAGE KS
66206-1355
US

IV. Provider business mailing address

8340 MISSION RD
PRAIRIE VILLAGE KS
66206-1355
US

V. Phone/Fax

Practice location:
  • Phone: 913-213-3531
  • Fax:
Mailing address:
  • Phone: 620-937-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number17-04655
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: