Healthcare Provider Details

I. General information

NPI: 1982138574
Provider Name (Legal Business Name): ANGIE SCHRECK OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGIE R. JUUL OTR

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8880 NE 82ND TER
KANSAS CITY MO
64158-1313
US

IV. Provider business mailing address

8880 NE 82ND TER
KANSAS CITY MO
64158-1313
US

V. Phone/Fax

Practice location:
  • Phone: 816-437-8122
  • Fax: 816-407-9609
Mailing address:
  • Phone: 816-437-8122
  • Fax: 816-407-9609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2001010040
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number2001010040
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: