Provider Demographics
NPI:1407629165
Name:THOMAS-JEFFCOAT, CASSANDRA JOLENE (LMT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:JOLENE
Last Name:THOMAS-JEFFCOAT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 SHAMROCK LN
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:AR
Mailing Address - Zip Code:72934-9147
Mailing Address - Country:US
Mailing Address - Phone:479-651-0281
Mailing Address - Fax:
Practice Address - Street 1:607 MAIN ST
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-5111
Practice Address - Country:US
Practice Address - Phone:479-651-0281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8263225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist