Provider Demographics
NPI:1629534755
Name:CRAMER, CASSIDY ADELE (OTR)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:ADELE
Last Name:CRAMER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:ADELE
Other - Last Name:LANGFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 W HYDE PARK PL APT 602
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2356
Mailing Address - Country:US
Mailing Address - Phone:904-887-0016
Mailing Address - Fax:
Practice Address - Street 1:10300 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-3810
Practice Address - Country:US
Practice Address - Phone:904-887-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT18260225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist