Provider Demographics
NPI:1003257866
Name:KRAUS, KASSIDY JOY
Entity type:Individual
Prefix:
First Name:KASSIDY
Middle Name:JOY
Last Name:KRAUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KASSIDY
Other - Middle Name:JOY
Other - Last Name:KRAUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS OT
Mailing Address - Street 1:430 PANGBORN RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NY
Mailing Address - Zip Code:13076-3138
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8282 WILLETT PKWY
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-1306
Practice Address - Country:US
Practice Address - Phone:315-857-0800
Practice Address - Fax:315-857-0803
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017434225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist