Basic Information
| Provider Information | |||||||||
| NPI: | 1972989127 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BAUM | ||||||||
| FirstName: | KALEENA | ||||||||
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| Credential: | MS, ATC, LAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2130 WARE CIR | ||||||||
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| City: | ROLLA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 654012497 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1301 W 6TH AVE STE 207 | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740744381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057070900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2015 | ||||||||
| LastUpdateDate: | 08/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AT1273 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.