Provider Demographics
NPI:1588693311
Name:ESELY, KATE LEE (ATC)
Entity type:Individual
Prefix:MRS
First Name:KATE
Middle Name:LEE
Last Name:ESELY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:802 N RIVERSIDE RD STE 250
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-2560
Mailing Address - Country:US
Mailing Address - Phone:816-271-7676
Mailing Address - Fax:816-271-4952
Practice Address - Street 1:5110 MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3331
Practice Address - Country:US
Practice Address - Phone:816-671-9517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040157032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer