Provider Demographics
NPI:1154813608
Name:CASSANO, NICOLE MICHELE (OTR)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MICHELE
Last Name:CASSANO
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 1:37 DOWNES AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-4025
Mailing Address - Country:US
Mailing Address - Phone:917-873-5187
Mailing Address - Fax:
Practice Address - Street 1:200 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3329
Practice Address - Country:US
Practice Address - Phone:929-284-3318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022521225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist