Provider Demographics
NPI:1679989842
Name:MANCINI, CASSANDRA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:MANCINI
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W GLEBE RD APT C11
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-2684
Mailing Address - Country:US
Mailing Address - Phone:207-807-6096
Mailing Address - Fax:
Practice Address - Street 1:10588 CANTERBERRY RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-1930
Practice Address - Country:US
Practice Address - Phone:703-474-8342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006260225X00000X
DCOT010000962225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist