Healthcare Provider Details

I. General information

NPI: 1003749763
Provider Name (Legal Business Name): OTM KANSAS CITY COMMUNITY PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9609 E 67TH TER
RAYTOWN MO
64133-5809
US

IV. Provider business mailing address

3634 CLEVELAND AVE
KANSAS CITY MO
64128-2633
US

V. Phone/Fax

Practice location:
  • Phone: 816-288-7354
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHEAL GUNN JR.
Title or Position: PRESIDENT
Credential:
Phone: 816-786-1784