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NPI Code Detail

MEDICARE: CASSIDY LAND WILSON OTR/L

MEDICARE: CASSIDY LAND WILSON OTR/L
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
1225X00000XOccupational Therapist0119011245VA

General Provider Information

NPI Number : 1457219412
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSIDY LAND WILSON OTR/L
Provider Business Mailing Address
First Line : 6300 MONUMENT AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23226-2841
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3600 SAUNDERS AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23227-4328
Country : US
Telephone Number : 804-278-8977
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2026
Last Update Date : 01/09/2026

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