Provider Demographics
NPI:1821650268
Name:SABERS, KELLY RUTH (ATC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:RUTH
Last Name:SABERS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 S MURPHY ST APT 22307
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-1795
Mailing Address - Country:US
Mailing Address - Phone:319-430-5136
Mailing Address - Fax:
Practice Address - Street 1:1224 N HUSBAND ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-3613
Practice Address - Country:US
Practice Address - Phone:319-439-5136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-06
Last Update Date:2019-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer