Provider Demographics
NPI:1457661753
Name:CORLEY, CASSI MICHELE (COTA)
Entity Type:Individual
Prefix:
First Name:CASSI
Middle Name:MICHELE
Last Name:CORLEY
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 1:244 SW COUNTY ROAD 3140
Mailing Address - Street 2:
Mailing Address - City:PURDON
Mailing Address - State:TX
Mailing Address - Zip Code:76679-3044
Mailing Address - Country:US
Mailing Address - Phone:903-851-5247
Mailing Address - Fax:
Practice Address - Street 1:2401 DEVELOPMENT BLVD
Practice Address - Street 2:
Practice Address - City:BELLMEAD
Practice Address - State:TX
Practice Address - Zip Code:76705-2903
Practice Address - Country:US
Practice Address - Phone:254-296-8976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210969224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant