Healthcare Provider Details

I. General information

NPI: 1114880689
Provider Name (Legal Business Name): JOHNI LACORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 WYOMING ST
KANSAS CITY MO
64111-3945
US

IV. Provider business mailing address

10307 GODDARD ST APT 7
OVERLAND PARK KS
66214-3018
US

V. Phone/Fax

Practice location:
  • Phone: 816-753-6700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: