Provider Demographics
NPI:1346885290
Name:HAMAN, CASSIDY JEAN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:CASSIDY
Middle Name:JEAN
Last Name:HAMAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:CASSIDY
Other - Middle Name:JEAN
Other - Last Name:SUNSTROM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:10815 ROYAL YORK DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77303-2665
Mailing Address - Country:US
Mailing Address - Phone:660-342-4004
Mailing Address - Fax:
Practice Address - Street 1:1014 WINDSOR LAKES BLVD
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4886
Practice Address - Country:US
Practice Address - Phone:936-273-9424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212976224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant