Healthcare Provider Details

I. General information

NPI: 1306249669
Provider Name (Legal Business Name): KASEY CURRENCE ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E COLLEGE ST
MARSHALL MO
65340-3109
US

IV. Provider business mailing address

500 E COLLEGE ST
MARSHALL MO
65340-3109
US

V. Phone/Fax

Practice location:
  • Phone: 660-831-4195
  • Fax: 660-831-4038
Mailing address:
  • Phone: 660-831-4195
  • Fax: 660-831-4038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2013028779
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: