Provider Demographics
NPI:1588244271
Name:KOZIOL, CASSIDY LEIGH (OTR)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:LEIGH
Last Name:KOZIOL
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 1:6975 E PRINCESS DR APT 1043
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-4211
Mailing Address - Country:US
Mailing Address - Phone:603-651-3164
Mailing Address - Fax:
Practice Address - Street 1:6975 E PRINCESS DR APT 1043
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-4211
Practice Address - Country:US
Practice Address - Phone:603-651-3164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist