Provider Demographics
NPI:1659787406
Name:STAUTH, NAOMI KATHLEEN (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:KATHLEEN
Last Name:STAUTH
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 CREOLE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7192
Mailing Address - Country:US
Mailing Address - Phone:316-204-7208
Mailing Address - Fax:
Practice Address - Street 1:2025 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7827
Practice Address - Country:US
Practice Address - Phone:337-477-8214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAATH.2002622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer