Provider Demographics
NPI:1164026456
Name:KERSHNER, CASSIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:KERSHNER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972-2108
Mailing Address - Country:US
Mailing Address - Phone:570-617-0450
Mailing Address - Fax:
Practice Address - Street 1:213 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BLOOMFIELD
Practice Address - State:PA
Practice Address - Zip Code:17068-9657
Practice Address - Country:US
Practice Address - Phone:717-582-4346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC017214225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist