Basic Information
| Provider Information | |||||||||
| NPI: | 1437356938 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RASOR | ||||||||
| FirstName: | TOMMIE | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.S.CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7780 BLANDVILLE RD | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420016167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702171613 | ||||||||
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| Practice Location | |||||||||
| Address1: | 867 MCGUIRE AVE | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420014036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704426168 | ||||||||
| FaxNumber: | 2704436211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | KY-2948 | KY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 12501490 | 05 | KY | MEDICAID |