Provider Demographics
NPI:1346360120
Name:KASSIS, BETH ANNE (OTR)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANNE
Last Name:KASSIS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:ANNE
Other - Last Name:KASSIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:5000 WILLOWTREE COURT
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0819
Mailing Address - Country:US
Mailing Address - Phone:916-825-1281
Mailing Address - Fax:916-344-5168
Practice Address - Street 1:3240 ARDEN WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-486-5400
Practice Address - Fax:916-486-5445
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2374225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist