Provider Demographics
NPI:1285861484
Name:VICKERS, CINDY
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:VICKERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CINDRA
Other - Middle Name:
Other - Last Name:ROOTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14036 W 114TH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4800
Mailing Address - Country:US
Mailing Address - Phone:913-269-2532
Mailing Address - Fax:
Practice Address - Street 1:3651 COLLEGE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1910
Practice Address - Country:US
Practice Address - Phone:913-253-8980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2024-11-18
Deactivation Date:2022-09-29
Deactivation Code:
Reactivation Date:2024-11-14
Provider Licenses
StateLicense IDTaxonomies
WAOT60083658225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist