Provider Demographics
NPI:1265407886
Name:VANCE, GAYLE SANDERS (OTR)
Entity type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:SANDERS
Last Name:VANCE
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 1:14416 WINDSOR ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224-3669
Mailing Address - Country:US
Mailing Address - Phone:816-756-0780
Mailing Address - Fax:816-756-1677
Practice Address - Street 1:14416 WINDSOR ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224-3669
Practice Address - Country:US
Practice Address - Phone:816-756-0780
Practice Address - Fax:816-756-1677
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000148758225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist