Provider Demographics
NPI:1194869628
Name:PETERSON, CYNTHIA ANN (OTR)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:PETERSON
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:PO BOX 6165
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66106-0165
Mailing Address - Country:US
Mailing Address - Phone:913-281-2541
Mailing Address - Fax:913-281-0994
Practice Address - Street 1:2100 METROPOLITAN AVE
Practice Address - Street 2:SUITE 19
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66106-3061
Practice Address - Country:US
Practice Address - Phone:913-281-2541
Practice Address - Fax:913-281-0994
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1700257225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics