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NPI Code Detail

MEDICARE: MARCY LYNN KASSAHN MS OTR/L

MEDICARE: MARCY LYNN KASSAHN MS OTR/L
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
1225X00000XOccupational Therapist663WY

General Provider Information

NPI Number : 1548453046
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARCY LYNN KASSAHN MS OTR/L
Provider Business Mailing Address
First Line : 4180 MEADOW RDG
Second Line :
City : BURNS
State : WY
Zip : 82053-9554
Country : US
Telephone Number : 307-547-3538
Fax Number :
Provider Business Practice Location Address
First Line : 1330 PRAIRIE AVE
Second Line :
City : CHEYENNE
State : WY
Zip : 82009-4842
Country : US
Telephone Number : 307-778-8997
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2007
Last Update Date : 08/20/2007

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