Healthcare Provider Details

I. General information

NPI: 1457814089
Provider Name (Legal Business Name): KASEY CREASY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6515 WILLIAMSON RD
HOLLINS VA
24019-4629
US

IV. Provider business mailing address

2398 MORGANS MILL RD
GOODVIEW VA
24095-2772
US

V. Phone/Fax

Practice location:
  • Phone: 540-366-2243
  • Fax:
Mailing address:
  • Phone: 540-293-4791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119008040
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: