Provider Demographics
NPI:1780292136
Name:SERINA, CASLEA JOY
Entity type:Individual
Prefix:MS
First Name:CASLEA
Middle Name:JOY
Last Name:SERINA
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 1:3875 GEIST RD STE 402
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3564
Mailing Address - Country:US
Mailing Address - Phone:907-450-9962
Mailing Address - Fax:
Practice Address - Street 1:544 4TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4714
Practice Address - Country:US
Practice Address - Phone:907-450-9962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2183165225700000X
AK150512225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist