Provider Demographics
NPI:1023521002
Name:COX, CASSAUNDRA (MA607699564)
Entity type:Individual
Prefix:
First Name:CASSAUNDRA
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:MA607699564
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 E OLYMPIC DR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98546-9710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 SE MILE HILL DR STE 150
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3517
Practice Address - Country:US
Practice Address - Phone:360-874-0232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist