Provider Demographics
NPI:1194885772
Name:WRIGHT, CASSANDRA ELAINE (OTR)
Entity type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:ELAINE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:CASSANDRA
Other - Middle Name:ELAINE
Other - Last Name:FAIRLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:P.O. BOX 2402
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-0041
Mailing Address - Country:US
Mailing Address - Phone:770-861-5581
Mailing Address - Fax:770-505-0709
Practice Address - Street 1:2137 SUMMERCHASE DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-8140
Practice Address - Country:US
Practice Address - Phone:770-861-5581
Practice Address - Fax:770-505-0709
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003282225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist