Provider Demographics
NPI:1154519544
Name:SEDLACEK, CANDACE S (OTR)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:S
Last Name:SEDLACEK
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 1:12000 W 110TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-3938
Mailing Address - Country:US
Mailing Address - Phone:913-491-9404
Mailing Address - Fax:913-754-0365
Practice Address - Street 1:12000 W 110TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-3938
Practice Address - Country:US
Practice Address - Phone:913-491-9404
Practice Address - Fax:913-754-0365
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1700286225X00000X
MO2001022660225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist