Provider Demographics
NPI:1427780451
Name:STAHL, CASSANDRA (OTD, OTR)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:STAHL
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-5349
Mailing Address - Country:US
Mailing Address - Phone:765-674-4455
Mailing Address - Fax:765-674-3577
Practice Address - Street 1:4411 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-5349
Practice Address - Country:US
Practice Address - Phone:765-674-4455
Practice Address - Fax:765-674-3577
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31007744A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist