MEDICARE: CANDACE S SEDLACEK OTR

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	225X00000X	Occupational Therapist	1700286	KS
2	225X00000X	Occupational Therapist	2001022660	MO

General Provider Information

NPI Number	:	1154519544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE S SEDLACEK OTR

Provider Business Mailing Address
First Line	:	12000 W 110TH ST
Second Line	:	SUITE 400
City	:	OVERLAND PARK
State	:	KS
Zip	:	66210-3938
Country	:	US
Telephone Number	:	913-491-9404
Fax Number	:	913-754-0365

Provider Business Practice Location Address
First Line	:	12000 W 110TH ST
Second Line	:	SUITE 400
City	:	OVERLAND PARK
State	:	KS
Zip	:	66210-3938
Country	:	US
Telephone Number	:	913-491-9404
Fax Number	:	913-754-0365

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

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	10/10/2007

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