Provider Demographics
NPI:1588257745
Name:OLIVER, CASSIE RENE' (ATC, LAT, OTR/L)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:RENE'
Last Name:OLIVER
Suffix:
Gender:F
Credentials:ATC, LAT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 MORTON LN
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5709
Mailing Address - Country:US
Mailing Address - Phone:615-319-4728
Mailing Address - Fax:
Practice Address - Street 1:889 BELL RD STE A
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3101
Practice Address - Country:US
Practice Address - Phone:800-381-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6781225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist