MEDICARE: JEAN NEENAN

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001872	OTHER	MO	LICENSE #

General Provider Information

NPI Number	:	1912013434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN NEENAN

Provider Business Mailing Address
First Line	:	635 W 69TH TER
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64113-2058
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 BROADWAY ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-1208
Country	:	US
Telephone Number	:	816-241-4331
Fax Number	:

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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Directions to “ JEAN NEENAN ” Practice Location

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