Healthcare Provider Details

I. General information

NPI: 1366596520
Provider Name (Legal Business Name): NORTHLAND EARLY EDUCATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 N OAK TRFY
KANSAS CITY MO
64155-2471
US

IV. Provider business mailing address

8630 N OAK TRFY
KANSAS CITY MO
64155-2471
US

V. Phone/Fax

Practice location:
  • Phone: 816-420-9005
  • Fax: 816-420-9010
Mailing address:
  • Phone: 816-420-9005
  • Fax: 816-420-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number000623
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number117116
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2001031051
License Number StateMO

VIII. Authorized Official

Name: JILL A. BARTLETT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 816-420-9005