MEDICARE: CASSIDY PLUCKER

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	18279	NC

General Provider Information

NPI Number	:	1972455673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIDY PLUCKER

Provider Business Mailing Address
First Line	:	100 W FREMONT ST UNIT 101
Second Line	:
City	:	BURGAW
State	:	NC
Zip	:	28425-5543
Country	:	US
Telephone Number	:	910-679-8385
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 W FREMONT ST UNIT 101
Second Line	:
City	:	BURGAW
State	:	NC
Zip	:	28425-5543
Country	:	US
Telephone Number	:	910-679-8385
Fax Number	:

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

Provider Enumeration Date	:	02/13/2026
Last Update Date	:	04/18/2026

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Directions to “ CASSIDY PLUCKER ” Practice Location

Language	Start Address	Practice Location

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