Healthcare Provider Details

I. General information

NPI: 1215074521
Provider Name (Legal Business Name): TAMMY J BRUEGGER OT L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 MAIN ST
KANSAS CITY MO
64111-1921
US

IV. Provider business mailing address

13906 HEMLOCK ST
OVERLAND PARK KS
66223-1329
US

V. Phone/Fax

Practice location:
  • Phone: 816-841-2284
  • Fax: 816-753-7836
Mailing address:
  • Phone: 913-897-7213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number000228
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: