Provider Demographics
NPI:1023180981
Name:CASSADY, DWAIN
Entity Type:Individual
Prefix:MR
First Name:DWAIN
Middle Name:
Last Name:CASSADY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 IVY ST
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9389
Mailing Address - Country:US
Mailing Address - Phone:770-844-0206
Mailing Address - Fax:770-844-4487
Practice Address - Street 1:980 IVY ST
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9389
Practice Address - Country:US
Practice Address - Phone:770-844-0206
Practice Address - Fax:770-844-4487
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002770225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist