Provider Demographics
NPI:1154733954
Name:OGLESBY, KASEY (LMT)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 ROLLIE MOORE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-2351
Mailing Address - Country:US
Mailing Address - Phone:618-252-2225
Mailing Address - Fax:618-252-0512
Practice Address - Street 1:608 ROLLIE MOORE DR STE 2
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-2351
Practice Address - Country:US
Practice Address - Phone:618-252-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.016416225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist