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General NPI Number Information
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NPI Number | 1306369707
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Entity Type | Individual
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Provider Name | CASSANDRA DANIELLE TYCAST MOT, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 07/18/2017
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Provider Practice Location Address
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Address Line | 1100 NW 79TH DR
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City | PLANTATION
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State | FL
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Zip | 33322-5154
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Country | US
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Telephone | 512-577-1222
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 NW 79TH DR
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City | PLANTATION
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State | FL
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Zip | 33322-5154
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Country | US
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Telephone | 512-577-1222
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 18595
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License Number State | FL
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