Provider Demographics
NPI:1982814554
Name:QUINLIN, KELLY LEANN (ATC, LAT, CSCS)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LEANN
Last Name:QUINLIN
Suffix:
Gender:F
Credentials:ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-2712
Mailing Address - Country:US
Mailing Address - Phone:660-528-1670
Mailing Address - Fax:
Practice Address - Street 1:NORTHWEST MISSOURI STATE UNIVERSITY
Practice Address - Street 2:800 UNIVERSITY DRIVE, LAC 45
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-2712
Practice Address - Country:US
Practice Address - Phone:660-562-1545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030152612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer