Provider Demographics
NPI:1700290129
Name:BARKLEY, CASSIE MCDONALD (MS, LAT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:MCDONALD
Last Name:BARKLEY
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5046 HIGHWAY 17 BYP S
Mailing Address - Street 2:SUITE 202 AND 203
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-4503
Mailing Address - Country:US
Mailing Address - Phone:843-294-1941
Mailing Address - Fax:843-294-1945
Practice Address - Street 1:5046 HIGHWAY 17 BYP S
Practice Address - Street 2:SUITE 202 AND 203
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-4503
Practice Address - Country:US
Practice Address - Phone:843-294-1941
Practice Address - Fax:843-294-1945
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer