Provider Demographics
NPI:1376885632
Name:LINNEMAN, KALEN SCOTT (ATHLETIC TRAINER)
Entity Type:Individual
Prefix:
First Name:KALEN
Middle Name:SCOTT
Last Name:LINNEMAN
Suffix:
Gender:M
Credentials:ATHLETIC TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 PROSPECT DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-2615
Mailing Address - Country:US
Mailing Address - Phone:660-385-1006
Mailing Address - Fax:660-385-1028
Practice Address - Street 1:1706 PROSPECT DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-2615
Practice Address - Country:US
Practice Address - Phone:660-385-1006
Practice Address - Fax:660-385-1028
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100066972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer