Provider Demographics
NPI:1861035172
Name:KASPER, KORY MATTHEW
Entity Type:Individual
Prefix:
First Name:KORY
Middle Name:MATTHEW
Last Name:KASPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N PITTSBURG LNDG
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-8208
Mailing Address - Country:US
Mailing Address - Phone:217-210-1475
Mailing Address - Fax:
Practice Address - Street 1:117 N PITTSBURG LNDG
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-8208
Practice Address - Country:US
Practice Address - Phone:217-210-1475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer