Provider Demographics
NPI:1881104594
Name:THOMAS, KASEY R (DT)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DT
Other - Prefix:MRS
Other - First Name:KASEY
Other - Middle Name:R
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DT
Mailing Address - Street 1:1351 NEWTOWN PIKE BLDG 1
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1277
Mailing Address - Country:US
Mailing Address - Phone:859-253-1686
Mailing Address - Fax:
Practice Address - Street 1:3801 HORSEMINT TRL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2949
Practice Address - Country:US
Practice Address - Phone:859-368-3528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-07
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid