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General NPI Number Information
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NPI Number | 1568649754
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Entity Type | Organization
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Legal Business Name | BRENDA L CASSELBERRY
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Dates
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Enumeration Date | 01/30/2008
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Last Update Date | 01/07/2009
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Provider Practice Location Address
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Address Line | 2121 EXECUTIVE PARK DR
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City | OPELIKA
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State | AL
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Zip | 36801-6041
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Country | US
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Telephone | 334-705-0544
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Fax | 334-705-0531
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Provider Business Mailing Address
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Address Line | PO BOX 1268
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City | AUBURN
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State | AL
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Zip | 36831-1268
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Country | US
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Telephone | 334-705-0544
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Fax | 334-705-0548
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Authorized Official
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Title or Position | PHYSICIAN / PRESIDENT
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Name | DR. BRENDA L CASSELBERRY
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Credential | DPM
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Telephone | 334-705-0544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 132
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 132
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License Number State | AL
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