Provider Demographics
NPI:1144658733
Name:MAGGARD, CASSTINA LYNNE
Entity type:Individual
Prefix:MRS
First Name:CASSTINA
Middle Name:LYNNE
Last Name:MAGGARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 SUMAC ST
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-1018
Mailing Address - Country:US
Mailing Address - Phone:606-233-4857
Mailing Address - Fax:
Practice Address - Street 1:144 SUMAC ST
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1018
Practice Address - Country:US
Practice Address - Phone:606-233-4857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist