Provider Demographics
NPI:1134587538
Name:SPRADLIN, STEPHEN RANDALL (LMT)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:RANDALL
Last Name:SPRADLIN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9219 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64138-4226
Mailing Address - Country:US
Mailing Address - Phone:816-872-5605
Mailing Address - Fax:
Practice Address - Street 1:1810 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2109
Practice Address - Country:US
Practice Address - Phone:816-872-5605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011010266225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist