Provider Demographics
NPI:1609331636
Name:WALLEN, CASSANDRA MICHELLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:MICHELLE
Last Name:WALLEN
Suffix:
Gender:F
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 1:303 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-5209
Mailing Address - Country:US
Mailing Address - Phone:717-476-5579
Mailing Address - Fax:
Practice Address - Street 1:65 BILLERBECK ST
Practice Address - Street 2:
Practice Address - City:NEW OXFORD
Practice Address - State:PA
Practice Address - Zip Code:17350-9375
Practice Address - Country:US
Practice Address - Phone:717-624-4616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014105225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist