Provider Demographics
NPI:1760715742
Name:SANDS, KASSIE ELIZABETH
Entity Type:Individual
Prefix:
First Name:KASSIE
Middle Name:ELIZABETH
Last Name:SANDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KASSANDRA
Other - Middle Name:ELIZABETH
Other - Last Name:SANDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7204 SKYWAY
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-3280
Mailing Address - Country:US
Mailing Address - Phone:530-872-2103
Mailing Address - Fax:530-872-7784
Practice Address - Street 1:7204 SKYWAY
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-3280
Practice Address - Country:US
Practice Address - Phone:530-872-2103
Practice Address - Fax:530-872-7784
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor