Basic Information
Provider Information
NPI: 1689031593
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLANAGAN
FirstName: EMMYLOU
MiddleName: AMANDA
NamePrefix: MRS.
NameSuffix:  
Credential: OTD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 16913 OAKMONT DR
Address2: APT 11
City: OMAHA
State: NE
PostalCode: 681364117
CountryCode: US
TelephoneNumber: 4022161352
FaxNumber:  
Practice Location
Address1: 10000 W 75TH ST
Address2: STE.250
City: MERRIAM
State: KS
PostalCode: 662042209
CountryCode: US
TelephoneNumber: 8889131910
FaxNumber: 8779131174
Other Information
ProviderEnumerationDate: 01/22/2016
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X901114NEY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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