Healthcare Provider Details

I. General information

NPI: 1639905672
Provider Name (Legal Business Name): CASSAUNDRA MICHELLE GOMEZ OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 N ARIZONA AVE STE 106
CHANDLER AZ
85225-7122
US

IV. Provider business mailing address

3411 N 16TH ST APT 1088
PHOENIX AZ
85016-7168
US

V. Phone/Fax

Practice location:
  • Phone: 480-699-4845
  • Fax:
Mailing address:
  • Phone: 623-205-7842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOTH-009741
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-009741
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: