Provider Demographics
NPI:1114408051
Name:GRAZIANO, CASSIE MARIE (MOT, LOTR)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:MARIE
Last Name:GRAZIANO
Suffix:
Gender:F
Credentials:MOT, LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 BRYANT IRVIN RD N STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-7673
Mailing Address - Country:US
Mailing Address - Phone:817-738-9866
Mailing Address - Fax:817-738-3157
Practice Address - Street 1:4901 BRYANT IRVIN RD N STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7673
Practice Address - Country:US
Practice Address - Phone:817-738-9866
Practice Address - Fax:817-738-3157
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119258225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist