Provider Demographics
NPI:1588388722
Name:MYERS-KNAPP, CASSANDRA ANN (RDH, OMT)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ANN
Last Name:MYERS-KNAPP
Suffix:
Gender:F
Credentials:RDH, OMT
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:ANN
Other - Last Name:MYERS-KNAPP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH, OMT
Mailing Address - Street 1:11417 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:BAGLEY
Mailing Address - State:WI
Mailing Address - Zip Code:53801-9712
Mailing Address - Country:US
Mailing Address - Phone:608-765-1507
Mailing Address - Fax:
Practice Address - Street 1:11417 HICKORY RD
Practice Address - Street 2:
Practice Address - City:BAGLEY
Practice Address - State:WI
Practice Address - Zip Code:53801-9712
Practice Address - Country:US
Practice Address - Phone:608-765-1507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11005-16124Q00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No124Q00000XDental ProvidersDental Hygienist