Healthcare Provider Details

I. General information

NPI: 1881085082
Provider Name (Legal Business Name): CHERYL CASSATTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 05/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1297 WINTER GARDEN VINELAND RD SUITE 110
WINTER GARDEN FL
34787-6706
US

IV. Provider business mailing address

1221 W COLONIAL DR SUITE 300
ORLANDO FL
32804-7163
US

V. Phone/Fax

Practice location:
  • Phone: 407-852-3300
  • Fax: 407-905-0532
Mailing address:
  • Phone: 407-852-3300
  • Fax: 407-852-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT11519
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT11519
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: