Provider Demographics
NPI:1053638643
Name:REID, CASEY C (COTA)
Entity Type:Individual
Prefix:MISS
First Name:CASEY
Middle Name:C
Last Name:REID
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 1:2818 MULBERRY LN APT D
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5756
Mailing Address - Country:US
Mailing Address - Phone:910-494-8840
Mailing Address - Fax:
Practice Address - Street 1:2818 MULBERRY LN APT D
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5756
Practice Address - Country:US
Practice Address - Phone:910-494-8840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7484224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant