Provider Demographics
NPI:1114599206
Name:SELLS, CASSANDRA MARIE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:MARIE
Last Name:SELLS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:CASSIE
Other - Middle Name:M
Other - Last Name:SELLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4301 RENAISSANCE DR APT 220
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-1564
Mailing Address - Country:US
Mailing Address - Phone:515-570-9947
Mailing Address - Fax:
Practice Address - Street 1:2500 COUNTRY DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5356
Practice Address - Country:US
Practice Address - Phone:510-792-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22563225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist