Provider Demographics
NPI:1386158889
Name:HOLLANDER, CASSIDY BROOKE (OTR)
Entity type:Individual
Prefix:MS
First Name:CASSIDY
Middle Name:BROOKE
Last Name:HOLLANDER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1215
Mailing Address - Country:US
Mailing Address - Phone:646-675-6799
Mailing Address - Fax:
Practice Address - Street 1:774 MANOR RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7038
Practice Address - Country:US
Practice Address - Phone:718-983-0757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022118225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist