MEDICARE: LYN BROOKS PETRO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	17-01224	KS

General Provider Information

NPI Number	:	1154256444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYN BROOKS PETRO

Provider Business Mailing Address
First Line	:	12613 SAGAMORE RD
Second Line	:
City	:	LEAWOOD
State	:	KS
Zip	:	66209-1325
Country	:	US
Telephone Number	:	816-560-6192
Fax Number	:

Provider Business Practice Location Address
First Line	:	8012 STATE LINE RD
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66208-3722
Country	:	US
Telephone Number	:	913-706-0747
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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