Provider Demographics
NPI:1568613776
Name:CASAVANT, SANDRA LEE (BS IN OT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LEE
Last Name:CASAVANT
Suffix:
Gender:F
Credentials:BS IN OT
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:GILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS IN OT
Mailing Address - Street 1:67 BRAINERD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-1505
Mailing Address - Country:US
Mailing Address - Phone:802-524-7032
Mailing Address - Fax:
Practice Address - Street 1:67 BRAINERD ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1505
Practice Address - Country:US
Practice Address - Phone:802-524-7032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072-0000059225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist