Provider Demographics
NPI:1598121055
Name:DURANT, KASSANDRA (OTA)
Entity Type:Individual
Prefix:MISS
First Name:KASSANDRA
Middle Name:
Last Name:DURANT
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7594 MAIN ST
Mailing Address - Street 2:APT. 6
Mailing Address - City:NEWPORT
Mailing Address - State:NY
Mailing Address - Zip Code:13416-3428
Mailing Address - Country:US
Mailing Address - Phone:315-219-6915
Mailing Address - Fax:
Practice Address - Street 1:159 WEST FIRST ST.
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126
Practice Address - Country:US
Practice Address - Phone:315-342-9575
Practice Address - Fax:315-342-7664
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant