Provider Demographics
NPI:1013462357
Name:VERHOFF, KASSONDRA MAE (ATC, AT)
Entity Type:Individual
Prefix:
First Name:KASSONDRA
Middle Name:MAE
Last Name:VERHOFF
Suffix:
Gender:F
Credentials:ATC, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12012 TOWNSHIP ROAD 53
Mailing Address - Street 2:
Mailing Address - City:MOUNT CORY
Mailing Address - State:OH
Mailing Address - Zip Code:45868-9633
Mailing Address - Country:US
Mailing Address - Phone:567-208-8401
Mailing Address - Fax:
Practice Address - Street 1:4025 INDIAN RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-2226
Practice Address - Country:US
Practice Address - Phone:419-531-1693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.005074246Z00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program