Basic Information
Provider Information
NPI: 1780108746
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LUTHER
FirstName: SHARA
MiddleName: MICHELLE
NamePrefix:  
NameSuffix:  
Credential: OTD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10000 W 75TH ST STE 250
Address2:  
City: MERRIAM
State: KS
PostalCode: 662042218
CountryCode: US
TelephoneNumber: 8889131910
FaxNumber: 8779131174
Practice Location
Address1: 10000 W 75TH ST STE 250
Address2:  
City: MERRIAM
State: KS
PostalCode: 662042218
CountryCode: US
TelephoneNumber: 8889131910
FaxNumber: 8779131174
Other Information
ProviderEnumerationDate: 08/01/2017
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
225X00000X2130NEY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


Home