Provider Demographics
NPI:1629421391
Name:KASCEL THERAPY, LLC
Entity Type:Organization
Organization Name:KASCEL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:386-585-5955
Mailing Address - Street 1:10 WATKINS PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7643
Mailing Address - Country:US
Mailing Address - Phone:386-585-5955
Mailing Address - Fax:
Practice Address - Street 1:10 WATKINS PL
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-7643
Practice Address - Country:US
Practice Address - Phone:386-585-5955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL16000012825225X00000X
FLOT14766252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1871679233OtherNPI PERSONAL NUMBER