Provider Demographics
NPI:1043736978
Name:QUASMIEH, SANNA (MSOT OTR/L)
Entity Type:Individual
Prefix:
First Name:SANNA
Middle Name:
Last Name:QUASMIEH
Suffix:
Gender:F
Credentials:MSOT OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OVERLOOK WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-4840
Mailing Address - Country:US
Mailing Address - Phone:609-895-1224
Mailing Address - Fax:
Practice Address - Street 1:2277 ROUTE 33 STE 411
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690
Practice Address - Country:US
Practice Address - Phone:609-838-7284
Practice Address - Fax:609-838-7285
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014875225X00000X
NJ46TR00769800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ60147288Medicaid