Healthcare Provider Details

I. General information

NPI: 1255199543
Provider Name (Legal Business Name): PAIGE ALLISON SUSANKA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1174 NE DOUGLAS ST
LEES SUMMIT MO
64086-4602
US

IV. Provider business mailing address

PO BOX 650020 DEPT 5093
DALLAS TX
75265-0020
US

V. Phone/Fax

Practice location:
  • Phone: 816-875-3884
  • Fax: 816-524-5080
Mailing address:
  • Phone: 816-875-3884
  • Fax: 816-524-5080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2024008486
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-04271
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: