Provider Demographics
NPI:1194295279
Name:KASHMANIAN, CORTNEY MARISSA (OTR/L)
Entity type:Individual
Prefix:
First Name:CORTNEY
Middle Name:MARISSA
Last Name:KASHMANIAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CORTNEY
Other - Middle Name:MARISSA
Other - Last Name:DESPLAINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 COLLIER CIR
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:MA
Mailing Address - Zip Code:01562-1525
Mailing Address - Country:US
Mailing Address - Phone:774-922-2087
Mailing Address - Fax:
Practice Address - Street 1:484 MAIN ST STE 600
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1881
Practice Address - Country:US
Practice Address - Phone:800-244-2756
Practice Address - Fax:508-831-9768
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13003225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA13003OtherOCCUPATIONAL THERAPIST LICENSE