Healthcare Provider Details

I. General information

NPI: 1912785023
Provider Name (Legal Business Name): CASSIE LORRAINE AMIEVA-ICE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 BERRY PATCH CT
CASTLE HAYNE NC
28429-5473
US

IV. Provider business mailing address

2812 BERRY PATCH CT
CASTLE HAYNE NC
28429-5473
US

V. Phone/Fax

Practice location:
  • Phone: 910-604-8874
  • Fax: 910-672-7869
Mailing address:
  • Phone: 910-604-8874
  • Fax: 910-672-7869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number16285
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: