MEDICARE: CASEY SKIDMORE

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	020101-01	NY

General Provider Information

NPI Number	:	1194421693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY SKIDMORE

Provider Business Mailing Address
First Line	:	82 SYOSSET CIR
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-4808
Country	:	US
Telephone Number	:	516-652-5114
Fax Number	:

Provider Business Practice Location Address
First Line	:	423 CLAY PITTS RD
Second Line	:
City	:	EAST NORTHPORT
State	:	NY
Zip	:	11731-3801
Country	:	US
Telephone Number	:	631-368-5252
Fax Number	:

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

Provider Enumeration Date	:	02/06/2023
Last Update Date	:	05/26/2026

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Directions to “ CASEY SKIDMORE ” Practice Location

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