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NPI Code Detail

MEDICARE: MISS CASSIDEE NICOLE MCCLUSKEY COTA/L

MEDICARE: MISS CASSIDEE NICOLE MCCLUSKEY COTA/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant215924TX

General Provider Information

NPI Number : 1962059683
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS CASSIDEE NICOLE MCCLUSKEY COTA/L
Provider Business Mailing Address
First Line : 1836 SANTA FE DR
Second Line :
City : WEATHERFORD
State : TX
Zip : 76086-6422
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1836 SANTA FE DR
Second Line :
City : WEATHERFORD
State : TX
Zip : 76086-6422
Country : US
Telephone Number : 817-341-7611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2019
Last Update Date : 08/19/2019

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Directions to “ MISS CASSIDEE NICOLE MCCLUSKEY COTA/L” Practice Location

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