Provider Demographics
NPI:1184044000
Name:SPENCER, CASSANDRA NICOLE (MS, OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:CASSANDRA
Middle Name:NICOLE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SE SERVICE RD APT 329
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-6082
Mailing Address - Country:US
Mailing Address - Phone:910-246-0629
Mailing Address - Fax:910-246-2089
Practice Address - Street 1:205 SE SERVICE RD APT 329
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-6082
Practice Address - Country:US
Practice Address - Phone:910-246-0629
Practice Address - Fax:910-246-2089
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR5393225X00000X
TN4729225X00000X, 225X00000X
TX118308225X00000X
COOT.0005101225X00000X
NC8671225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist