Provider Demographics
NPI:1992910202
Name:GALLIVAN, SHARON MARIE (OT/L)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:MARIE
Last Name:GALLIVAN
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:MARIE
Other - Last Name:PARSONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT/L
Mailing Address - Street 1:8365 RENNER BLVD
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-3087
Mailing Address - Country:US
Mailing Address - Phone:785-424-0255
Mailing Address - Fax:
Practice Address - Street 1:12802 JOHNSON DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-1645
Practice Address - Country:US
Practice Address - Phone:913-738-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-00503225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist