MEDICARE: ALLORA NICOLE NUTTER 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	17-02257	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17-02257	OTHER	KS	STATE LISCENSE

General Provider Information

NPI Number	:	1639325145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLORA NICOLE NUTTER OTR

Provider Business Mailing Address
First Line	:	8033 MADISON AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-2249
Country	:	US
Telephone Number	:	826-268-1940
Fax Number	:

Provider Business Practice Location Address
First Line	:	8033 MADISON AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-2249
Country	:	US
Telephone Number	:	826-268-1940
Fax Number	:

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

Provider Enumeration Date	:	08/15/2008
Last Update Date	:	08/15/2008

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