Provider Demographics
NPI:1174864698
Name:WHITE, CASSANDRA (OTR/L)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:WHITE
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 1:9817 CASTLE HWY
Mailing Address - Street 2:
Mailing Address - City:PLEASUREVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40057-8605
Mailing Address - Country:US
Mailing Address - Phone:502-321-0618
Mailing Address - Fax:
Practice Address - Street 1:500 MERIDIAN HILLS DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:KY
Practice Address - Zip Code:40243-2234
Practice Address - Country:US
Practice Address - Phone:502-245-0655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3806225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist