Provider Demographics
NPI:1437611811
Name:FUNCTIONAL PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:FUNCTIONAL PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:L
Authorized Official - Last Name:SKELTON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:913-309-7591
Mailing Address - Street 1:16383 CANTRELL RD
Mailing Address - Street 2:
Mailing Address - City:BONNER SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66012-7622
Mailing Address - Country:US
Mailing Address - Phone:913-309-7591
Mailing Address - Fax:
Practice Address - Street 1:15630 PINEHURST DR STE 1
Practice Address - Street 2:
Practice Address - City:BASEHOR
Practice Address - State:KS
Practice Address - Zip Code:66007-8238
Practice Address - Country:US
Practice Address - Phone:913-728-2065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty