Provider Demographics
NPI:1255995833
Name:DIDOMENICO, CASAUNDRA LYNNE (OTR/L)
Entity type:Individual
Prefix:
First Name:CASAUNDRA
Middle Name:LYNNE
Last Name:DIDOMENICO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 BRINTON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:PA
Mailing Address - Zip Code:19373-1003
Mailing Address - Country:US
Mailing Address - Phone:484-983-9573
Mailing Address - Fax:
Practice Address - Street 1:9 LACRUE AVE STE 103
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1062
Practice Address - Country:US
Practice Address - Phone:484-840-1529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP009591224Z00000X
PAOC020279225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant