Provider Demographics
NPI:1346813359
Name:GOODENOUGH, CASSANDRA (OTR/L)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:GOODENOUGH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:
Other - Last Name:GOODENOUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:577 NOR AM RD
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27863-8581
Mailing Address - Country:US
Mailing Address - Phone:919-750-3038
Mailing Address - Fax:
Practice Address - Street 1:105 HUNT VALLEY DR
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4992
Practice Address - Country:US
Practice Address - Phone:910-892-6427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10855225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist