Provider Demographics
NPI:1417607870
Name:GASKIN, KELLI
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:GASKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 FOUNDERS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7105
Mailing Address - Country:US
Mailing Address - Phone:803-800-9878
Mailing Address - Fax:803-661-8309
Practice Address - Street 1:305 FOUNDERS RIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7105
Practice Address - Country:US
Practice Address - Phone:803-800-9878
Practice Address - Fax:803-661-8309
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC63624225000000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter