MEDICARE: NICOLE MICHELE CASSANO OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	022521	NY

General Provider Information

NPI Number	:	1154813608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MICHELE CASSANO OTR

Provider Business Mailing Address
First Line	:	37 DOWNES AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-4025
Country	:	US
Telephone Number	:	917-873-5187
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 JEFFERSON BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3329
Country	:	US
Telephone Number	:	929-284-3318
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2018
Last Update Date	:	12/13/2021

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Directions to “ NICOLE MICHELE CASSANO OTR” Practice Location

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