Provider Demographics
NPI:1285626937
Name:ST. NICHOLAS CHILDREN'S THERAPIES LLC
Entity Type:Organization
Organization Name:ST. NICHOLAS CHILDREN'S THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWBER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERZOG
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:913-579-8556
Mailing Address - Street 1:3811 W 52ND ST
Mailing Address - Street 2:
Mailing Address - City:ROELAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66205-1458
Mailing Address - Country:US
Mailing Address - Phone:913-579-8556
Mailing Address - Fax:
Practice Address - Street 1:3811 W 52ND ST
Practice Address - Street 2:
Practice Address - City:ROELAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66205-1458
Practice Address - Country:US
Practice Address - Phone:913-579-8556
Practice Address - Fax:816-763-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO34966016OtherBCBS OF KANSAS CITY GROUP
MO=========OtherGREAT-WEST HC GROUP #
MO=========OtherGREAT-WEST HC GROUP #
Q33540Medicare UPIN