Provider Demographics
NPI:1669598371
Name:SLATE, CASSANDRA RENEE I (COTA)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:RENEE
Last Name:SLATE
Suffix:I
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 1:5300 HUGHES CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:HUGHESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25110
Mailing Address - Country:US
Mailing Address - Phone:304-442-2849
Mailing Address - Fax:
Practice Address - Street 1:1000 LINCOLN DRIVE
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309
Practice Address - Country:US
Practice Address - Phone:304-768-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAC1603224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant