Provider Demographics
NPI:1154810570
Name:GRESHOW, CASSIE JANELLE
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:JANELLE
Last Name:GRESHOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3596 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-9322
Mailing Address - Country:US
Mailing Address - Phone:989-501-1995
Mailing Address - Fax:
Practice Address - Street 1:1201 E MICHIGAN AVE STE 320
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1854
Practice Address - Country:US
Practice Address - Phone:517-205-7633
Practice Address - Fax:517-205-7634
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009439225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist