Provider Demographics
NPI:1326133885
Name:FILLMAN, CASSIE L (RD)
Entity Type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:L
Last Name:FILLMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 SILVERSPRING DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7420
Mailing Address - Country:US
Mailing Address - Phone:512-461-1149
Mailing Address - Fax:
Practice Address - Street 1:6500 N MOPAC
Practice Address - Street 2:BLDG. III, STE 220
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-338-4500
Practice Address - Fax:512-338-4501
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX932554133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J2093Medicare UPIN