Healthcare Provider Details

I. General information

NPI: 1144055179
Provider Name (Legal Business Name): KASEY WESTMORELAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 VILLA CT
HARTWELL GA
30643-7220
US

IV. Provider business mailing address

35 VILLA CT
HARTWELL GA
30643-7220
US

V. Phone/Fax

Practice location:
  • Phone: 706-599-8801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT004792
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: