Provider Demographics
NPI:1780099564
Name:KASPER, JEANNIE LOUISE (PTA)
Entity type:Individual
Prefix:MS
First Name:JEANNIE
Middle Name:LOUISE
Last Name:KASPER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-3301
Mailing Address - Country:US
Mailing Address - Phone:765-825-4115
Mailing Address - Fax:765-825-0422
Practice Address - Street 1:1029 E 5TH ST
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-3301
Practice Address - Country:US
Practice Address - Phone:765-825-4115
Practice Address - Fax:765-825-0422
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002647A174400000X
TX2087940174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist