Provider Demographics
NPI:1568089118
Name:CASPER, ADAM (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:CASPER
Suffix:
Gender:M
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TROBACK DR
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:PA
Mailing Address - Zip Code:18643-1230
Mailing Address - Country:US
Mailing Address - Phone:570-362-2047
Mailing Address - Fax:
Practice Address - Street 1:423 SCRANTON CARBONDALE HWY
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1115
Practice Address - Country:US
Practice Address - Phone:570-207-5502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC016148225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty