Provider Demographics
NPI:1457371593
Name:ANDERSON, GAY LYNN (ATC)
Entity Type:Individual
Prefix:MS
First Name:GAY
Middle Name:LYNN
Last Name:ANDERSON
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 1:409 E 74TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1636
Mailing Address - Country:US
Mailing Address - Phone:816-786-8682
Mailing Address - Fax:
Practice Address - Street 1:11901 WORNALL RD
Practice Address - Street 2:AVILA UNIVERSITY, M112
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64145-1007
Practice Address - Country:US
Practice Address - Phone:816-501-3742
Practice Address - Fax:816-941-4503
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001726042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer