Provider Demographics
NPI:1003051566
Name:CAIRNS, MARK ALLEN (AT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:CAIRNS
Suffix:
Gender:M
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21062 W 118TH TER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5562
Mailing Address - Country:US
Mailing Address - Phone:785-424-4892
Mailing Address - Fax:785-842-3410
Practice Address - Street 1:1305 WAKARUSA DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049
Practice Address - Country:US
Practice Address - Phone:785-842-3444
Practice Address - Fax:785-842-3410
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-000032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer