MEDICARE: BRIGHT START THERAPY, LLC

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	252Y00000X	Early Intervention Provider Agency	3619	KS

General Provider Information

NPI Number	:	1245642347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT START THERAPY, LLC

Provider Business Mailing Address
First Line	:	4300 W 63RD ST
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66208-1505
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 W 63RD ST
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66208-1505
Country	:	US
Telephone Number	:	816-916-9115
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	ANN L KIRKLAND
Credential	:	MS, CCC-SLP
Telephone Number	:	816-916-9115

Provider Enumeration Date	:	05/22/2014
Last Update Date	:	05/22/2014

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Directions to “BRIGHT START THERAPY, LLC ” Practice Location

Language	Start Address	Practice Location

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