Provider Demographics
NPI:1396044186
Name:CASSIDY, KRISTIN (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:HOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:1338 PINETREE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4718
Mailing Address - Country:US
Mailing Address - Phone:314-750-0752
Mailing Address - Fax:
Practice Address - Street 1:11660 EDDIE AND PARK RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126
Practice Address - Country:US
Practice Address - Phone:314-750-0752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010037675225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics