Individual
BRENDAN SIMARD MCSHANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
4383 SW BREEZY POINT LN, LEES SUMMIT, MO 64082-4771
(816) 210-4102
Mailing address
4383 SW BREEZY POINT LN, LEES SUMMIT, MO 64082-4771
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
17-02788
KS
225X00000X
Occupational Therapist
Primary
2012005417
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17-02788
KANSAS STATE LICENSE
KS
01
—
2012005417
STATE LICENSE
MO
Enumeration date
11/09/2009
Last updated
08/11/2020
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