Provider Demographics
NPI:1447098702
Name:CASSIDY, KAITLYN (OTR)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 W RENNER RD APT 1424
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-1353
Mailing Address - Country:US
Mailing Address - Phone:214-797-5799
Mailing Address - Fax:
Practice Address - Street 1:280 W RENNER RD APT 1424
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-1353
Practice Address - Country:US
Practice Address - Phone:214-797-5799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist