Provider Demographics
NPI:1255044731
Name:SLAGLE, KASEY MICHELLE (LMT)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:MICHELLE
Last Name:SLAGLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SLAGLE LN
Mailing Address - Street 2:
Mailing Address - City:BRONSTON
Mailing Address - State:KY
Mailing Address - Zip Code:42518-9583
Mailing Address - Country:US
Mailing Address - Phone:606-875-6403
Mailing Address - Fax:
Practice Address - Street 1:3311 S HIGHWAY 27 STE 4
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-3179
Practice Address - Country:US
Practice Address - Phone:606-875-6403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY280937225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty