Basic Information
| Provider Information | |||||||||
| NPI: | 1740604644 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WIDENER | ||||||||
| FirstName: | CASSANDRA | ||||||||
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| Credential: | M.S., OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 W 3RD ST | ||||||||
| Address2: | |||||||||
| City: | SHERIDAN | ||||||||
| State: | WY | ||||||||
| PostalCode: | 828013606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076722092 | ||||||||
| FaxNumber: | 3076731969 | ||||||||
| Practice Location | |||||||||
| Address1: | 13336 INDUSTRIAL RD STE 105 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023303211 | ||||||||
| FaxNumber: | 4023305970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2014 | ||||||||
| LastUpdateDate: | 08/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 2204 | NE | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | OTR-1138 | WY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | OT-1117 | ID | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.