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General NPI Number Information
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NPI Number | 1992910202
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Entity Type | Individual
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Provider Name | SHARON MARIE GALLIVAN OT/L
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Gender | Female
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 12802 JOHNSON DR
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City | SHAWNEE
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State | KS
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Zip | 66216-1645
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Country | US
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Telephone | 913-738-2090
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Fax |
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Provider Business Mailing Address
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Address Line | 8365 RENNER BLVD
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City | LENEXA
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State | KS
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Zip | 66219-3087
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Country | US
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Telephone | 785-424-0255
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 17-00503
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License Number State | KS
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