Provider Demographics
NPI:1366267668
Name:DICK, JAMES (OTR/L)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:DICK
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 E 129TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64145-1355
Mailing Address - Country:US
Mailing Address - Phone:913-278-9387
Mailing Address - Fax:
Practice Address - Street 1:1415 MAPLE ST
Practice Address - Street 2:
Practice Address - City:EUDORA
Practice Address - State:KS
Practice Address - Zip Code:66025-9419
Practice Address - Country:US
Practice Address - Phone:785-542-2176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03428225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist