Provider Demographics
NPI:1578892766
Name:PEARL, GWENDOLYN R (OTR)
Entity Type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:R
Last Name:PEARL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 N 110TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-3463
Mailing Address - Country:US
Mailing Address - Phone:913-721-5335
Mailing Address - Fax:
Practice Address - Street 1:3310 N 110TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-3463
Practice Address - Country:US
Practice Address - Phone:913-721-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090350572251E1200X, 225XE0001X, 225XG0600X
MO20090305057225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation