MEDICARE: NORTHLAND EARLY EDUCATION CENTER

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	000623	MO
2	235Z00000X	Speech-Language Pathologist	117116	MO
3	2251P0200X	Pediatric Physical Therapist	2001031051	MO

General Provider Information

NPI Number	:	1366596520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHLAND EARLY EDUCATION CENTER

Provider Business Mailing Address
First Line	:	8630 N OAK TRFY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-2471
Country	:	US
Telephone Number	:	816-420-9005
Fax Number	:	816-420-9010

Provider Business Practice Location Address
First Line	:	8630 N OAK TRFY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-2471
Country	:	US
Telephone Number	:	816-420-9005
Fax Number	:	816-420-9010

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JILL A. BARTLETT
Credential	:
Telephone Number	:	816-420-9005

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	12/05/2014

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