Provider Demographics
NPI:1578703062
Name:NELSON, CASSIDY MARIE
Entity Type:Individual
Prefix:MRS
First Name:CASSIDY
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CASSIDY
Other - Middle Name:MARIE
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2685 PELHAM PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-1354
Mailing Address - Country:US
Mailing Address - Phone:205-621-6503
Mailing Address - Fax:205-621-6507
Practice Address - Street 1:2685 PELHAM PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-1354
Practice Address - Country:US
Practice Address - Phone:205-621-6503
Practice Address - Fax:205-621-6507
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2997225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist