Provider Demographics
NPI:1003066820
Name:SPIVEY-JOHNSON, CASSANDRA MARIA
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:MARIA
Last Name:SPIVEY-JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S DIXON AVE
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-3202
Mailing Address - Country:US
Mailing Address - Phone:919-815-1195
Mailing Address - Fax:
Practice Address - Street 1:1130 FALLS RIVER AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7772
Practice Address - Country:US
Practice Address - Phone:919-803-2912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6979225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist