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General NPI Number Information
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NPI Number | 1295043719
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Entity Type | Individual
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Provider Name | ASHLEY NICOLE GASSAWAY OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/17/2010
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Last Update Date | 09/17/2010
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Provider Practice Location Address
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Address Line | 1101 GOETZ BLVD
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City | JOPLIN
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State | MO
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Zip | 64801-1431
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Country | US
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Telephone | 417-629-3044
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Fax |
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Provider Business Mailing Address
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Address Line | 1983 S FARM ROAD 69
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City | REPUBLIC
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State | MO
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Zip | 65738-2690
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Country | US
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Telephone | 417-619-1424
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2010028133
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License Number State | MO
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