Provider Demographics
NPI:1255199543
Name:SUSANKA, PAIGE ALLISON
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:ALLISON
Last Name:SUSANKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22120 MIDLAND DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-3554
Mailing Address - Country:US
Mailing Address - Phone:913-745-4064
Mailing Address - Fax:
Practice Address - Street 1:11340 NALL AVE STE 200B
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1234
Practice Address - Country:US
Practice Address - Phone:913-354-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-04271225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist