Healthcare Provider Details

I. General information

NPI: 1922902303
Provider Name (Legal Business Name): CASSIDY LEAH HIGGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 S MAIN ST
ADA OH
45810-6000
US

IV. Provider business mailing address

6610 MAPLEBROOK AVE NE
EAST CANTON OH
44730-1944
US

V. Phone/Fax

Practice location:
  • Phone: 234-410-5189
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number060004193
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: