Individual
ASHLEY NICOLE GASSAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1101 GOETZ BLVD, JOPLIN, MO 64801-1431
(417) 629-3044
Mailing address
1983 S FARM ROAD 69, REPUBLIC, MO 65738-2690
(417) 619-1424
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2010028133
MO
Other
Enumeration date
09/17/2010
Last updated
09/17/2010
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