Provider Demographics
NPI:1093456139
Name:EARLE, JAYME STEPHEN (LAT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:STEPHEN
Last Name:EARLE
Suffix:
Gender:M
Credentials:LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23201 NE 164TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060-9280
Mailing Address - Country:US
Mailing Address - Phone:816-560-8973
Mailing Address - Fax:
Practice Address - Street 1:398 BLUE JAY DR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1977
Practice Address - Country:US
Practice Address - Phone:816-407-2315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210365182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer