Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 131113 | KY |
NPI | 1063635209 |
---|---|
Provider Name | Crystal D Cassity |
First Address | Chicago, IL 60677-6351 |
Second Address | Louisville, KY 40207-4721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 24/07/2017 |