Provider Demographics
NPI:1952537466
Name:KASYAN, KATHLEEN ANNE (OTR)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANNE
Last Name:KASYAN
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 1:803 HIGHLAND AVE
Mailing Address - Street 2:APARTMENT #3
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-6406
Mailing Address - Country:US
Mailing Address - Phone:765-413-7741
Mailing Address - Fax:
Practice Address - Street 1:803 HIGHLAND AVE
Practice Address - Street 2:APARTMENT #3
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-6406
Practice Address - Country:US
Practice Address - Phone:765-413-7741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003284A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist