Provider Demographics
NPI:1023154143
Name:STALCUP, KRISTA SUE (OTR)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:SUE
Last Name:STALCUP
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 N HULL CT
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2602
Mailing Address - Country:US
Mailing Address - Phone:816-746-4960
Mailing Address - Fax:
Practice Address - Street 1:5703 N HULL CT
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2602
Practice Address - Country:US
Practice Address - Phone:816-746-4960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000059225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist