Provider Demographics
NPI:1154864429
Name:OPENSHAW, CASSANDRA (OTR)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:OPENSHAW
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 1:235 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILBRIDGE
Mailing Address - State:ME
Mailing Address - Zip Code:04658-3413
Mailing Address - Country:US
Mailing Address - Phone:207-546-0723
Mailing Address - Fax:
Practice Address - Street 1:120 EDGEVIEW DR APT 5208
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-8091
Practice Address - Country:US
Practice Address - Phone:207-546-0723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 18137225X00000X
COOT0005172225X00000X
225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX40597407OtherLICENSE