Provider Demographics
NPI:1811699317
Name:KNEELAND, ASHLEY DIANE (LMT)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:DIANE
Last Name:KNEELAND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1107 E. 13TH STREET
Mailing Address - Street 2:SUITES A&B
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-7955
Mailing Address - Country:US
Mailing Address - Phone:918-786-8834
Mailing Address - Fax:918-786-6520
Practice Address - Street 1:1107 E. 13TH STREET
Practice Address - Street 2:SUITES A&B
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-7955
Practice Address - Country:US
Practice Address - Phone:918-786-8834
Practice Address - Fax:918-786-6520
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK182924225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist