1316453699 NPI number — KORI STAAB

Table of content: KORI STAAB (NPI 1316453699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316453699 NPI number — KORI STAAB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAAB
Provider First Name:
KORI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316453699
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24690 MO HWY 92
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLATTE CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
64079-1966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-410-8426
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24690 MO HWY 92
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLATTE CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
64079-1966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-410-8426
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , with the licence number:  RBT-15-09756 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106S00000X , with the licence number: RBT-17-38877 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225A00000X , with the licence number: 13586 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RBT-17-38877 . This is a "RBT (REGISTERED BEHAVIOR TECHNICIAN)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201230650 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 13586 . This is a "MT-BC (MUSIC THERAPIST BOARD CERTIFIED)" identifier . This identifiers is of the category "OTHER".