Healthcare Provider Details

I. General information

NPI: 1699667352
Provider Name (Legal Business Name): CASSIDY JEAN MCHENRY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 FURYS FERRY RD
MARTINEZ GA
30907-9057
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 706-210-9380
  • Fax: 706-650-1896
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT009621
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: