Provider Demographics
NPI:1467844639
Name:BEUERLEIN, CASSANDRA NOEL (COTA/L)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:NOEL
Last Name:BEUERLEIN
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 1:1610 E. SUNSHINE STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804
Mailing Address - Country:US
Mailing Address - Phone:417-523-7500
Mailing Address - Fax:417-523-7595
Practice Address - Street 1:1610 E. SUNSHINE STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804
Practice Address - Country:US
Practice Address - Phone:417-523-7500
Practice Address - Fax:417-523-7595
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012006013172V00000X
MO201200613224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No172V00000XOther Service ProvidersCommunity Health Worker