Healthcare Provider Details

I. General information

NPI: 1538291224
Provider Name (Legal Business Name): BRIAN S. MILLS OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 02/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7405 RENNER RD KU MEDWEST THERAPY
SHAWNEE KS
66217-9414
US

IV. Provider business mailing address

2330 SHAWNEE MISSION PKWY MEDICAL ADMINISTRATIVE SERVICES OF KU MED, STE. 312
WESTWOOD KS
66205-2005
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-3510
  • Fax: 913-588-3508
Mailing address:
  • Phone: 913-588-9000
  • Fax: 913-588-9822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-01897
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: