Provider Demographics
NPI:1508266339
Name:HANCOCK, KASEY ANN (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:ANN
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4338 N CYPRESS LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-8505
Mailing Address - Country:US
Mailing Address - Phone:803-459-6262
Mailing Address - Fax:
Practice Address - Street 1:39 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-1526
Practice Address - Country:US
Practice Address - Phone:317-834-3930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235500000X, 2255A2300X, 390200000X
OHAT0056242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program