Provider Demographics
NPI:1548453046
Name:KASSAHN, MARCY LYNN (MS OTR/L)
Entity type:Individual
Prefix:
First Name:MARCY
Middle Name:LYNN
Last Name:KASSAHN
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4180 MEADOW RDG
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:WY
Mailing Address - Zip Code:82053-9554
Mailing Address - Country:US
Mailing Address - Phone:307-547-3538
Mailing Address - Fax:
Practice Address - Street 1:1330 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4842
Practice Address - Country:US
Practice Address - Phone:307-778-8997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY663225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist