Provider Demographics
NPI:1558534693
Name:OETTING, STACY ANN (MPT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:OETTING
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W DOUGLAS AVE STE 1040
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3017
Mailing Address - Country:US
Mailing Address - Phone:316-263-0003
Mailing Address - Fax:
Practice Address - Street 1:8437 STATE AVE
Practice Address - Street 2:STE B
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1842
Practice Address - Country:US
Practice Address - Phone:913-299-9616
Practice Address - Fax:913-299-9617
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115364225100000X
KS1102938225100000X
IA03699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist