Provider Demographics
NPI:1164004057
Name:KEIR, KASSIE LYNN
Entity Type:Individual
Prefix:
First Name:KASSIE
Middle Name:LYNN
Last Name:KEIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KASSIE
Other - Middle Name:LYNN
Other - Last Name:DAMIANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1202 TECH BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-7863
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1202 TECH BLVD STE 104
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-7863
Practice Address - Country:US
Practice Address - Phone:813-438-6796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician