Healthcare Provider Details

I. General information

NPI: 1760392104
Provider Name (Legal Business Name): CASSANDRA EICHEN WEINMAN-SPARKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 CROWNPOINT EXECUTIVE DR UNIT J
CHARLOTTE NC
28227-7824
US

IV. Provider business mailing address

10520 PACES AVE APT 1418
MATTHEWS NC
28105-3052
US

V. Phone/Fax

Practice location:
  • Phone: 704-799-6824
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number10998
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: