MEDICARE: CASSANDRA FAYE HUMPHREY

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

General Provider Information

NPI Number	:	1801632393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA FAYE HUMPHREY

Provider Business Mailing Address
First Line	:	824 DENALI DR
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-9186
Country	:	US
Telephone Number	:	606-802-1095
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 SHOPPERS DR
Second Line	:
City	:	WINCHESTER
State	:	KY
Zip	:	40391-2808
Country	:	US
Telephone Number	:	859-385-4195
Fax Number	:

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

Provider Enumeration Date	:	07/03/2024
Last Update Date	:	03/16/2026

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