Basic Information
| Provider Information | |||||||||
| NPI: | 1164190161 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOLONEY | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | OTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1323 ELM ST | ||||||||
| Address2: | |||||||||
| City: | ALMOND | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549099792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7154124879 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3107 WESTHILL DR | ||||||||
| Address2: | |||||||||
| City: | WAUSAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544013774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167721105 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2021 | ||||||||
| LastUpdateDate: | 09/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 5792-27 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.