Provider Demographics
NPI:1831605542
Name:BUTZ, KAELA
Entity type:Individual
Prefix:MRS
First Name:KAELA
Middle Name:
Last Name:BUTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KAELA
Other - Middle Name:
Other - Last Name:HASENBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 SE STEEPLE DR
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-3846
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2609 GLENN HENDREN DR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3313
Practice Address - Country:US
Practice Address - Phone:816-479-4793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant