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Individual

MRS. KASI BROOK GANNON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR/L

Contact information

Practice address
2016 S MAYO TRL, PIKEVILLE, KY 41501-2295
(606) 422-3200
Mailing address
2016 S MAYO TRL, PIKEVILLE, KY 41501-2295
(606) 422-3200

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
175362
KY
225X00000X
Occupational Therapist
Primary
240762
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
240762
LICENSE NUMBER
KY
05
240762
KY
Enumeration date
11/14/2017
Last updated
06/16/2018
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