Healthcare Provider Details

I. General information

NPI: 1518301803
Provider Name (Legal Business Name): ANNA MARIE CASADOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 05/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 COLWELL ST
CRANSTON RI
02920-4206
US

IV. Provider business mailing address

471 ATWOOD AVE
CRANSTON RI
02920-5316
US

V. Phone/Fax

Practice location:
  • Phone: 401-944-3242
  • Fax: 401-944-3425
Mailing address:
  • Phone: 401-944-3242
  • Fax: 401-944-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZA2600X
TaxonomyMedical Art Specialist/Technologist
License NumberTA00509
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: