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General NPI Number Information
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NPI Number | 1710797238
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Entity Type | Individual
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Provider Name | CASSIE ELLIS
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Gender | Female
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Dates
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Enumeration Date | 01/08/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 8420 UNIVERSITY EXEC PARK DR STE 825
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City | CHARLOTTE
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State | NC
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Zip | 28262-1346
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Country | US
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Telephone | 704-752-1616
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Fax |
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Provider Business Mailing Address
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Address Line | 5113 PIPER STATION DR STE 103
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City | CHARLOTTE
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State | NC
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Zip | 28277-6690
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Country | US
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Telephone |
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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 | 225XF0002X
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Taxonomy Name | Feeding, Eating & Swallowing Occupational Therapist
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License Number | 17492
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 17492
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 17492
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License Number State | NC
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