Provider Demographics
NPI:1245016765
Name:FLOYD, CASSIDY (COTA)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:FLOYD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 POPLAR AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-7506
Mailing Address - Country:US
Mailing Address - Phone:901-728-6912
Mailing Address - Fax:901-701-2428
Practice Address - Street 1:4515 POPLAR AVE STE 210
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-7506
Practice Address - Country:US
Practice Address - Phone:901-728-6912
Practice Address - Fax:901-701-2428
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4028224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant