Provider Demographics
NPI:1477690717
Name:LAWLESS, CASSANDRA MICHELLE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:MICHELLE
Last Name:LAWLESS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:CASSANDRA
Other - Middle Name:MICHELLE
Other - Last Name:KENNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:PO BOX 4596
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-4596
Mailing Address - Country:US
Mailing Address - Phone:307-734-2877
Mailing Address - Fax:
Practice Address - Street 1:310 EAST BROADWAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:307-734-2877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR705225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY21283Medicare PIN