Provider Demographics
NPI:1477269702
Name:HOUGHTLEN, KASSY MICHELLE
Entity type:Individual
Prefix:
First Name:KASSY
Middle Name:MICHELLE
Last Name:HOUGHTLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 MONTCLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1323
Mailing Address - Country:US
Mailing Address - Phone:419-706-4152
Mailing Address - Fax:
Practice Address - Street 1:2520 MONTCLAIR AVE
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1323
Practice Address - Country:US
Practice Address - Phone:419-706-4152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide