Provider Demographics
NPI:1699945253
Name:PATZIG, CASSIE FULLINGIM (OTR)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:FULLINGIM
Last Name:PATZIG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 4TH ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-4348
Mailing Address - Country:US
Mailing Address - Phone:806-791-3399
Mailing Address - Fax:806-791-3934
Practice Address - Street 1:6110 NASHVILLE AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-5216
Practice Address - Country:US
Practice Address - Phone:806-792-0604
Practice Address - Fax:806-792-0604
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112546225XP0200X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX330993YVXQMedicare PIN