Provider Demographics
NPI:1669268496
Name:BASSHAM, LAINE MARIE (OT)
Entity type:Individual
Prefix:MRS
First Name:LAINE
Middle Name:MARIE
Last Name:BASSHAM
Suffix:
Gender:
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20707 W 108TH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-3195
Mailing Address - Country:US
Mailing Address - Phone:913-475-8801
Mailing Address - Fax:
Practice Address - Street 1:8200 W 71ST ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-1715
Practice Address - Country:US
Practice Address - Phone:913-475-8801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-02778225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics