Provider Demographics
NPI:1316453699
Name:STAAB, KORI
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:
Last Name:STAAB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24690 MO HWY 92
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:64079-1966
Mailing Address - Country:US
Mailing Address - Phone:785-410-8426
Mailing Address - Fax:
Practice Address - Street 1:24690 MO HWY 92
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:KS
Practice Address - Zip Code:64079-1966
Practice Address - Country:US
Practice Address - Phone:785-410-8426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-15-09756106S00000X
RBT-17-38877106S00000X
13586225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-17-38877OtherRBT (REGISTERED BEHAVIOR TECHNICIAN)
KS201230650Medicaid
13586OtherMT-BC (MUSIC THERAPIST BOARD CERTIFIED)