Individual
MR. CALEB DIEDERICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 234-3000
Mailing address
21439 W 121ST ST, OLATHE, KS 66061-5601
(785) 747-6315
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
05-35604
MO
2255A2300X
Athletic Trainer
Primary
24-01018
KS
Other
Enumeration date
05/03/2022
Last updated
05/03/2022
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