Provider Demographics
NPI:1265682108
Name:LATIMER CLEVENGER, CASSANDRA M (MS, ATC)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:M
Last Name:LATIMER CLEVENGER
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-2431
Mailing Address - Country:US
Mailing Address - Phone:304-634-5145
Mailing Address - Fax:
Practice Address - Street 1:4024 MACCORKLE AVE SW
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1510
Practice Address - Country:US
Practice Address - Phone:304-768-7671
Practice Address - Fax:304-768-6491
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer