Provider Demographics
NPI:1144275728
Name:CASIAN (FLECK), CARISA LEE (MOTR/L)
Entity type:Individual
Prefix:MS
First Name:CARISA
Middle Name:LEE
Last Name:CASIAN (FLECK)
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:CARISA
Other - Middle Name:LEE
Other - Last Name:FLECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:844 N ELLSWORTH
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-5114
Mailing Address - Country:US
Mailing Address - Phone:480-380-2810
Mailing Address - Fax:480-380-2861
Practice Address - Street 1:844 N ELLSWORTH
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-5114
Practice Address - Country:US
Practice Address - Phone:480-380-2810
Practice Address - Fax:480-380-2861
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3626225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist