Provider Demographics
NPI:1760558217
Name:CASSETORI, MICHELE LEE (OTR L)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEE
Last Name:CASSETORI
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 1:1086 ROUTE 315
Mailing Address - Street 2:PRO REHABILITATION SERVICES
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18702
Mailing Address - Country:US
Mailing Address - Phone:570-823-7761
Mailing Address - Fax:570-822-8033
Practice Address - Street 1:1086 ROUTE 315
Practice Address - Street 2:PRO REHABILITATION SERVICES
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18702
Practice Address - Country:US
Practice Address - Phone:570-823-7761
Practice Address - Fax:570-822-8033
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002739L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
418488OtherHEALTH AMERICA ASSURANCE
442527OtherHEALTH AMERICA ASSURANCE
815825OtherFIRST PRIORITY
1471691OtherBLUE SHIELD
442526OtherHEALTH AMERICA ASSURANCE
810398OtherFIRST PRIORITY
813832OtherFIRST PRIORITY