Provider Demographics
NPI:1598900185
Name:CASSIDY, GARY WARD (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:WARD
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-1831
Mailing Address - Country:US
Mailing Address - Phone:631-584-7526
Mailing Address - Fax:631-862-0123
Practice Address - Street 1:243 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-1831
Practice Address - Country:US
Practice Address - Phone:631-584-7526
Practice Address - Fax:631-862-0123
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002944225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist