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General NPI Number Information
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NPI Number | 1912493040
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Entity Type | Individual
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Provider Name | KEVIN D CAZEAULT OTR/L
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Gender | Male
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Dates
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Enumeration Date | 07/01/2018
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Last Update Date | 07/01/2018
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Provider Practice Location Address
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Address Line | 3955 SE 182ND AVE
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City | GRESHAM
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State | OR
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Zip | 97030
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Country | US
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Telephone | 503-665-0183
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Fax |
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Provider Business Mailing Address
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Address Line | 935 GARDENGATE PL APT F
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-4687
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Country | US
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Telephone | 603-969-2517
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 349496
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License Number State | OR
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