Provider Demographics
NPI:1083338636
Name:HEDRICK, CASSIDY (OTR)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:HEDRICK
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 1:811 PINHOOK RD
Mailing Address - Street 2:
Mailing Address - City:PETERSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:24963-9314
Mailing Address - Country:US
Mailing Address - Phone:716-361-8211
Mailing Address - Fax:
Practice Address - Street 1:1600 E CLIFF DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5130
Practice Address - Country:US
Practice Address - Phone:915-975-8630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist