Individual
CHARLIEY AMBER STAAB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10000 W 75TH ST STE 250, MERRIAM, KS 66204-2218
(785) 577-6326
Mailing address
11307 W 65TH ST APT 102, SHAWNEE, KS 66203-5514
(785) 577-6326
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
14-02715
KS
Other
Enumeration date
12/13/2013
Last updated
10/08/2014
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