Provider Demographics
NPI:1275606956
Name:COLLIER, TRACEY R (OT)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:R
Last Name:COLLIER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10777 NALL AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1362
Mailing Address - Country:US
Mailing Address - Phone:913-279-0243
Mailing Address - Fax:913-279-0564
Practice Address - Street 1:10777 NALL AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1362
Practice Address - Country:US
Practice Address - Phone:913-279-0243
Practice Address - Fax:913-279-0564
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0756225X00000X
KS17-02478225X00000X
MO002675225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist