Provider Demographics
NPI:1154688398
Name:VACEK, KRIS M (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:KRIS
Middle Name:M
Last Name:VACEK
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 W 61ST TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-1455
Mailing Address - Country:US
Mailing Address - Phone:816-405-8494
Mailing Address - Fax:
Practice Address - Street 1:8900 STATE LINE RD
Practice Address - Street 2:STE. 333
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-1960
Practice Address - Country:US
Practice Address - Phone:913-491-9404
Practice Address - Fax:913-754-0365
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004094225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist