Provider Demographics
NPI:1033582374
Name:CALTRIDER, CASSONDRA (COTA)
Entity Type:Individual
Prefix:MS
First Name:CASSONDRA
Middle Name:
Last Name:CALTRIDER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 ADAMS LN APT 71
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2610
Mailing Address - Country:US
Mailing Address - Phone:740-221-4056
Mailing Address - Fax:
Practice Address - Street 1:1825 ADAMS LN APT 71
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2610
Practice Address - Country:US
Practice Address - Phone:740-221-4056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC1993224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant