Provider Demographics
NPI:1437927886
Name:REEVER, CASSIE ALISE (COTA/L)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:ALISE
Last Name:REEVER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2394 HIGHWAY 221
Mailing Address - Street 2:
Mailing Address - City:DOE RUN
Mailing Address - State:MO
Mailing Address - Zip Code:63637-3213
Mailing Address - Country:US
Mailing Address - Phone:573-783-9316
Mailing Address - Fax:
Practice Address - Street 1:18729 JACKAL DR
Practice Address - Street 2:
Practice Address - City:MARBLE HILL
Practice Address - State:MO
Practice Address - Zip Code:63764-2689
Practice Address - Country:US
Practice Address - Phone:573-238-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017000076224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant