Provider Demographics
NPI:1124241732
Name:CRICHLOW, CASSANDRA ADELIA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:ADELIA
Last Name:CRICHLOW
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:CASSANDRA
Other - Middle Name:ADELIA
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:28 SHADE ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-1769
Mailing Address - Country:US
Mailing Address - Phone:617-308-8466
Mailing Address - Fax:
Practice Address - Street 1:28 SHADE ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-1769
Practice Address - Country:US
Practice Address - Phone:617-308-8466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6919225XP0200X, 225XP0019X, 225XF0002X, 225XH1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
No225XH1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHuman Factors