=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730544537
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THRESA MARY KUSSMAN OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2015
-----------------------------------------------------
Last Update Date | 12/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15301 W 87TH ST SUITE 200
-----------------------------------------------------
City | LENEXA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66219-1401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-492-4888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 302 W HARRISON ST
-----------------------------------------------------
City | BRUNSWICK
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65236-1021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-589-9460
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 17-01324
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 004032
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------