Provider Demographics
NPI:1568064152
Name:THOMASON, KASSONDRA DAWN (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:KASSONDRA
Middle Name:DAWN
Last Name:THOMASON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 W KEY WEST DR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-5257
Mailing Address - Country:US
Mailing Address - Phone:520-208-5319
Mailing Address - Fax:
Practice Address - Street 1:442 W KORTSEN RD STE 202
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5923
Practice Address - Country:US
Practice Address - Phone:520-208-5319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ046868224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant