=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659842474
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFF DAILEY LMT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2018
-----------------------------------------------------
Last Update Date | 12/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 N MUR LEN RD STE 103
-----------------------------------------------------
City | OLATHE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66062-1794
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-440-4142
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7199 W 98TH TER STE 150
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66212-6158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-406-4990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 19-T-00146
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------