Provider Demographics
NPI:1073146098
Name:QUATTLEBAUM, KAYLEE (ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:KAYLEE
Middle Name:
Last Name:QUATTLEBAUM
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MO
Mailing Address - Zip Code:64098-1044
Mailing Address - Country:US
Mailing Address - Phone:816-589-7153
Mailing Address - Fax:
Practice Address - Street 1:327 S RIDGE AVE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-2151
Practice Address - Country:US
Practice Address - Phone:816-589-7153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180272162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer