Provider Demographics
NPI:1598395691
Name:ASHER, KELLIE MARIE (DPT)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:MARIE
Last Name:ASHER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 COUNTY ROAD 408
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:MO
Mailing Address - Zip Code:65256-9601
Mailing Address - Country:US
Mailing Address - Phone:660-734-0835
Mailing Address - Fax:
Practice Address - Street 1:1630 RADIO HILL RD
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-1957
Practice Address - Country:US
Practice Address - Phone:660-882-6584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014039414208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty