Provider Demographics
NPI:1285863993
Name:WHITEHEAD, CASSANDRA L (COTA)
Entity Type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:L
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4246 GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46409-2032
Mailing Address - Country:US
Mailing Address - Phone:219-455-5517
Mailing Address - Fax:219-753-0511
Practice Address - Street 1:6100 MILLER AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46403-2469
Practice Address - Country:US
Practice Address - Phone:219-763-0511
Practice Address - Fax:219-763-0511
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3201616A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant