Provider Demographics
NPI:1396243689
Name:JASSO, KASSANDRA RODRIGUEZ (OTR)
Entity type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:RODRIGUEZ
Last Name:JASSO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KASSANDRA
Other - Middle Name:VENEGAS
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:850 TOWER DR STE 112
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4252
Mailing Address - Country:US
Mailing Address - Phone:432-614-0268
Mailing Address - Fax:888-972-6512
Practice Address - Street 1:850 TOWER DR STE 112
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4252
Practice Address - Country:US
Practice Address - Phone:432-614-0268
Practice Address - Fax:888-972-6512
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118894225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist