Provider Demographics
NPI:1619073475
Name:CASELLI, KATHRYN ANN (OTR)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:CASELLI
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 VANCE DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-5706
Mailing Address - Country:US
Mailing Address - Phone:423-989-9111
Mailing Address - Fax:423-989-9111
Practice Address - Street 1:245 NORTH ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3274
Practice Address - Country:US
Practice Address - Phone:276-669-4711
Practice Address - Fax:276-669-0834
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000001757225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNOT0000001757OtherO.T. LICENSE NUMBER
VA0119003649OtherO.T. LICENSE NUMBER