Provider Demographics
NPI:1306369707
Name:TYCAST, CASSANDRA DANIELLE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:DANIELLE
Last Name:TYCAST
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:DANIELLE
Other - Last Name:TYCAST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:1100 NW 79TH DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5154
Mailing Address - Country:US
Mailing Address - Phone:512-577-1222
Mailing Address - Fax:
Practice Address - Street 1:1100 NW 79TH DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5154
Practice Address - Country:US
Practice Address - Phone:512-577-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18595225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist