Provider Demographics
NPI:1386609139
Name:DEBLAUW, CASSANDRA MARIE (MS, ATC)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:MARIE
Last Name:DEBLAUW
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 N EAST ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2110
Mailing Address - Country:US
Mailing Address - Phone:660-785-7272
Mailing Address - Fax:
Practice Address - Street 1:100 E NORMAL ST
Practice Address - Street 2:PERSHING BUILDING 122
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-4200
Practice Address - Country:US
Practice Address - Phone:660-785-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050207552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer