Provider Demographics
NPI:1730682782
Name:WOODS, BRONNA RENEE (OTR)
Entity type:Individual
Prefix:
First Name:BRONNA
Middle Name:RENEE
Last Name:WOODS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:BRONNA
Other - Middle Name:RENEE
Other - Last Name:BEADLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16005 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:KS
Mailing Address - Zip Code:66085-9346
Mailing Address - Country:US
Mailing Address - Phone:785-554-0868
Mailing Address - Fax:
Practice Address - Street 1:4101 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5014
Practice Address - Country:US
Practice Address - Phone:913-682-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013023270225X00000X
KS17-00612225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist