Provider Demographics
NPI:1326429283
Name:MCCASLAND, JENNIFER (OTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MCCASLAND
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:WEST CHAZY
Mailing Address - State:NY
Mailing Address - Zip Code:12992-2562
Mailing Address - Country:US
Mailing Address - Phone:518-324-3520
Mailing Address - Fax:518-324-3698
Practice Address - Street 1:37 EAGLE WAY
Practice Address - Street 2:
Practice Address - City:WEST CHAZY
Practice Address - State:NY
Practice Address - Zip Code:12992
Practice Address - Country:US
Practice Address - Phone:518-324-3520
Practice Address - Fax:518-324-3698
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP97060224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant