Provider Demographics
NPI:1790162824
Name:NIEMELA, CASSANDRA (ATC, SCAT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:NIEMELA
Suffix:
Gender:F
Credentials:ATC, SCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2110
Mailing Address - Country:US
Mailing Address - Phone:908-577-6600
Mailing Address - Fax:
Practice Address - Street 1:4 RIDGE DR
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-2110
Practice Address - Country:US
Practice Address - Phone:908-577-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1477390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program