Provider Demographics
NPI:1548407208
Name:SANTIAGO, CASSANDRA R (OTR/L)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:R
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 NE 28TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-2229
Mailing Address - Country:US
Mailing Address - Phone:407-399-6103
Mailing Address - Fax:
Practice Address - Street 1:1733 NE 28TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-2229
Practice Address - Country:US
Practice Address - Phone:407-399-6103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12629314000000X
WAOT00004569225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility