Provider Demographics
NPI:1538754593
Name:HAIRELL, KASEY LYNN (LAT,ATC)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:LYNN
Last Name:HAIRELL
Suffix:
Gender:F
Credentials:LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1549 COUNTY ROAD 182
Mailing Address - Street 2:
Mailing Address - City:HALLETTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77964-5835
Mailing Address - Country:US
Mailing Address - Phone:361-772-4252
Mailing Address - Fax:
Practice Address - Street 1:1549 COUNTY ROAD 182
Practice Address - Street 2:
Practice Address - City:HALLETTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77964-5835
Practice Address - Country:US
Practice Address - Phone:361-772-4252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXAT90312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program