Healthcare Provider Details

I. General information

NPI: 1811529167
Provider Name (Legal Business Name): KASIE BELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

953 DANBY RD
ITHACA NY
14850-7000
US

IV. Provider business mailing address

18 TIMBERLINE DR
PENFIELD NY
14526-9750
US

V. Phone/Fax

Practice location:
  • Phone: 585-978-1075
  • Fax:
Mailing address:
  • Phone: 585-978-1075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: