Provider Demographics
NPI:1730592247
Name:CASALA, KRISTIAN ANTHONY
Entity type:Individual
Prefix:
First Name:KRISTIAN ANTHONY
Middle Name:
Last Name:CASALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 E JOPPA RD
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-9315
Mailing Address - Country:US
Mailing Address - Phone:202-375-9043
Mailing Address - Fax:
Practice Address - Street 1:5009 E JOPPA RD
Practice Address - Street 2:
Practice Address - City:PERRY HALL
Practice Address - State:MD
Practice Address - Zip Code:21128-9315
Practice Address - Country:US
Practice Address - Phone:202-375-9043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07161225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist