Provider Demographics
NPI:1922681352
Name:MEDINA, CASSANDRA IRIS (OTR)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:IRIS
Last Name:MEDINA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 E MONTE CRISTO RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-0334
Mailing Address - Country:US
Mailing Address - Phone:956-583-4544
Mailing Address - Fax:956-583-4545
Practice Address - Street 1:1901 E MONTE CRISTO RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-0334
Practice Address - Country:US
Practice Address - Phone:956-583-4544
Practice Address - Fax:956-583-4545
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120377225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist