Provider Demographics
NPI:1548743453
Name:STOOTS, KELLY COLLEEN (MS, ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:COLLEEN
Last Name:STOOTS
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:COLLEEN
Other - Last Name:BASKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:940 W HIGHWAY 290
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-3862
Mailing Address - Country:US
Mailing Address - Phone:210-858-3225
Mailing Address - Fax:
Practice Address - Street 1:940 W HIGHWAY 290
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-3862
Practice Address - Country:US
Practice Address - Phone:210-858-3225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXA58612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer