Provider Demographics
NPI:1891963534
Name:HOLMES, CASSANDRA VICTORIA (LMT, NCTMB)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:VICTORIA
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:VICTORIA
Other - Last Name:RASMUSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, NCTMB
Mailing Address - Street 1:2300 BIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4105
Mailing Address - Country:US
Mailing Address - Phone:541-608-7077
Mailing Address - Fax:
Practice Address - Street 1:2300 BIDDLE RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4105
Practice Address - Country:US
Practice Address - Phone:541-608-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9582225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist