Provider Demographics
NPI:1366893612
Name:STICKLER, KELLIE (DPT)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:STICKLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:
Other - Last Name:HANDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12121 BLUE RIDGE EXT
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-6401
Mailing Address - Country:US
Mailing Address - Phone:816-761-8088
Mailing Address - Fax:816-761-8923
Practice Address - Street 1:12121 BLUE RIDGE EXT
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-6401
Practice Address - Country:US
Practice Address - Phone:816-761-8088
Practice Address - Fax:816-761-8923
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016022331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist