Individual
MRS. KAREN MYCANKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR CHT CLT
Contact information
Practice address
1700 RAINBOW BLVD, EXCELSIOR SPRINGS, MO 64024-1182
(816) 629-2700
(816) 629-2723
Mailing address
1700 RAINBOW BOULEVARD, EXCELSIOR SPRINGS, MO 64024
(816) 629-2700
(816) 629-2723
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
000014
MO
225X00000X
Occupational Therapist
000014
MO
225XH1200X
Hand Occupational Therapist
Primary
9811000110
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20217047
BCBS
MO
Enumeration date
05/03/2006
Last updated
06/19/2013
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