Provider Demographics
NPI:1386901205
Name:KASHI, STACEY ANN (OTR/L, C/NDT)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ANN
Last Name:KASHI
Suffix:
Gender:F
Credentials:OTR/L, C/NDT
Other - Prefix:MISS
Other - First Name:STACEY
Other - Middle Name:ANN
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, C/NDT
Mailing Address - Street 1:10721 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1518
Mailing Address - Country:US
Mailing Address - Phone:954-474-1418
Mailing Address - Fax:
Practice Address - Street 1:10721 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1518
Practice Address - Country:US
Practice Address - Phone:954-474-1418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT2907225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00544600Medicaid