Basic Information
| Provider Information | |||||||||
| NPI: | 1568089118 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASPER | ||||||||
| FirstName: | ADAM | ||||||||
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| Credential: | MS OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 TROBACK DR | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 186431230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703622047 | ||||||||
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| Practice Location | |||||||||
| Address1: | 423 SCRANTON CARBONDALE HWY | ||||||||
| Address2: | |||||||||
| City: | SCRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185081115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702075502 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2020 | ||||||||
| LastUpdateDate: | 06/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0019X | OC016148 | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation |
No ID Information.