Provider Demographics
NPI:1215395561
Name:MCCURDY, CASSIDY LEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:LEE
Last Name:MCCURDY
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:PO BOX 2782
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94953-2782
Mailing Address - Country:US
Mailing Address - Phone:805-944-0328
Mailing Address - Fax:
Practice Address - Street 1:191 LYNCH CREEK WAY STE 204
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2389
Practice Address - Country:US
Practice Address - Phone:707-200-3577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24129225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist