MEDICARE: JOSEPH CHARLES CONKLIN JR. 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	2001012271	MO

General Provider Information

NPI Number	:	1720422967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH CHARLES CONKLIN JR. OTR/L

Provider Business Mailing Address
First Line	:	4145 HOLMES ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64110-1127
Country	:	US
Telephone Number	:	816-977-6966
Fax Number	:	816-523-0169

Provider Business Practice Location Address
First Line	:	2323 SWOPE PKWY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64130-2638
Country	:	US
Telephone Number	:	816-924-1122
Fax Number	:	816-523-0169

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

Provider Enumeration Date	:	04/18/2013
Last Update Date	:	04/18/2013

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