Provider Demographics
NPI:1548800865
Name:SHORT, KASEY (OTR/L)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:SHORT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:
Other - Last Name:SHORT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2146 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-3757
Mailing Address - Country:US
Mailing Address - Phone:361-772-3086
Mailing Address - Fax:
Practice Address - Street 1:2146 AUGUSTA DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-3757
Practice Address - Country:US
Practice Address - Phone:613-772-3086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115923225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist