Healthcare Provider Details

I. General information

NPI: 1710814686
Provider Name (Legal Business Name): CASSANDRA WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 13640
FLORENCE SC
29504-3640
US

IV. Provider business mailing address

PO BOX 13640
FLORENCE SC
29504-3640
US

V. Phone/Fax

Practice location:
  • Phone: 843-245-2469
  • Fax:
Mailing address:
  • Phone: 843-245-2469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberRCP4928
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: