Provider Demographics
NPI:1417907783
Name:KASSIMIR, JOANNE I (OTR, CHT)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:I
Last Name:KASSIMIR
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807A S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3610
Mailing Address - Country:US
Mailing Address - Phone:410-939-2262
Mailing Address - Fax:
Practice Address - Street 1:555 CONCORD STREET UNIT C
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-4258
Practice Address - Country:US
Practice Address - Phone:516-662-6177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XH1200X
MD08884225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ54751Medicare PIN
NY5304130001Medicare NSC