Provider Demographics
NPI:1174294086
Name:KUBEJA, KASSIDY (OT)
Entity type:Individual
Prefix:
First Name:KASSIDY
Middle Name:
Last Name:KUBEJA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KASSIDY
Other - Middle Name:
Other - Last Name:O'KEEFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:4247 W RIDGE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-1746
Mailing Address - Country:US
Mailing Address - Phone:814-833-7249
Mailing Address - Fax:814-838-2661
Practice Address - Street 1:4247 W RIDGE RD STE 104
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-1746
Practice Address - Country:US
Practice Address - Phone:814-833-7249
Practice Address - Fax:814-838-2661
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2024-12-03
Deactivation Date:2024-09-23
Deactivation Code:
Reactivation Date:2024-11-01
Provider Licenses
StateLicense IDTaxonomies
PAOC017874225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist