Provider Demographics
NPI:1346934767
Name:KRASK, KASEY LYNN (OTA)
Entity Type:Individual
Prefix:MRS
First Name:KASEY
Middle Name:LYNN
Last Name:KRASK
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 1:113 ROYAL TROON DR
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3295
Mailing Address - Country:US
Mailing Address - Phone:210-388-8763
Mailing Address - Fax:
Practice Address - Street 1:816 EVERYDAY WAY
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-4080
Practice Address - Country:US
Practice Address - Phone:210-538-3812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210506224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant