MEDICARE: THERESA BILLMEYER CASSIDY OTD, OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	0000804	CO

General Provider Information

NPI Number	:	1548214760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA BILLMEYER CASSIDY OTD, OTR

Provider Business Mailing Address
First Line	:	2924 BEACON ST STE D
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-6195
Country	:	US
Telephone Number	:	719-231-6657
Fax Number	:

Provider Business Practice Location Address
First Line	:	2924 BEACON ST STE D
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-6195
Country	:	US
Telephone Number	:	719-231-6657
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	05/22/2023

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