Provider Demographics
NPI:1437600673
Name:WOOD, CASSANDRA (COTA)
Entity Type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 ANDERSON COUNTY RD 1200
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:TX
Mailing Address - Zip Code:75839
Mailing Address - Country:US
Mailing Address - Phone:903-922-3610
Mailing Address - Fax:
Practice Address - Street 1:201 W LANCASTER AVE
Practice Address - Street 2:UNIT 210
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-6663
Practice Address - Country:US
Practice Address - Phone:903-922-3601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210288224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant