MEDICARE: FANNY MARGARET MANDELBERGER OTR/L

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	17-0317	KS

General Provider Information

NPI Number	:	1295243053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FANNY MARGARET MANDELBERGER OTR/L

Provider Business Mailing Address
First Line	:	10000 W 75TH ST STE 121
Second Line	:
City	:	SHAWNEE MISSION
State	:	KS
Zip	:	66204-2241
Country	:	US
Telephone Number	:	913-362-7518
Fax Number	:

Provider Business Practice Location Address
First Line	:	11228 MILITARY CLUB RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64138-3621
Country	:	US
Telephone Number	:	913-362-7518
Fax Number	:

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

Provider Enumeration Date	:	01/15/2018
Last Update Date	:	04/12/2021

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