Provider Demographics
NPI:1750821237
Name:GASH, KELSEY (ATC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:GASH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16075 TALLADEGA DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65010-7731
Mailing Address - Country:US
Mailing Address - Phone:573-819-9716
Mailing Address - Fax:
Practice Address - Street 1:501 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-1299
Practice Address - Country:US
Practice Address - Phone:573-819-9716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190102322255A2300X
NE8492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer