Provider Demographics
NPI:1306219324
Name:KAVANAUGH, CASSIE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:KAVANAUGH
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 1:5400 NW 39TH AVE
Mailing Address - Street 2:APT DD289
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6962
Mailing Address - Country:US
Mailing Address - Phone:352-256-9241
Mailing Address - Fax:
Practice Address - Street 1:5400 NW 39TH AVE
Practice Address - Street 2:APT DD289
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6962
Practice Address - Country:US
Practice Address - Phone:352-256-9241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 39182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer