Provider Demographics
NPI:1265233894
Name:YANT, CASSIDY ROSE (MSOT, OTR/L)
Entity type:Individual
Prefix:MISS
First Name:CASSIDY
Middle Name:ROSE
Last Name:YANT
Suffix:
Gender:
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E PICKWICK DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:IN
Mailing Address - Zip Code:46567-1713
Mailing Address - Country:US
Mailing Address - Phone:574-216-1839
Mailing Address - Fax:
Practice Address - Street 1:106 E PICKWICK DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:IN
Practice Address - Zip Code:46567-1713
Practice Address - Country:US
Practice Address - Phone:574-216-1839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31008667A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist