Provider Demographics
NPI:1376115600
Name:CANTRELL, CASSIDY MORGAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:MORGAN
Last Name:CANTRELL
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 1:8245 PECK RD
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-9772
Mailing Address - Country:US
Mailing Address - Phone:330-221-7634
Mailing Address - Fax:330-296-8025
Practice Address - Street 1:8245 PECK RD
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-9772
Practice Address - Country:US
Practice Address - Phone:330-221-7634
Practice Address - Fax:330-296-8025
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT011518225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist