Provider Demographics
NPI:1689218729
Name:DEBOER, NATALIE JO (LAT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:JO
Last Name:DEBOER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:MISS
Other - First Name:NATALIE
Other - Middle Name:JO
Other - Last Name:SELLERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:3928 DAYFLOWER ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-7800
Mailing Address - Country:US
Mailing Address - Phone:785-766-7930
Mailing Address - Fax:
Practice Address - Street 1:1112 W 6TH ST STE 124
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2249
Practice Address - Country:US
Practice Address - Phone:785-843-9125
Practice Address - Fax:785-505-5312
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-008492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer