Provider Demographics
NPI:1245445725
Name:KASEL, WANDA LEE (OTR)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:LEE
Last Name:KASEL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4490 CORRAL RD
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20187-5812
Mailing Address - Country:US
Mailing Address - Phone:480-209-5796
Mailing Address - Fax:
Practice Address - Street 1:14115 LOVERS LN
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-4157
Practice Address - Country:US
Practice Address - Phone:480-209-5796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1664225XP0200X
VA0119008596225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ468290OtherAHCCCS