Provider Demographics
NPI:1467242842
Name:CASOLO, LENA
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:CASOLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-6626
Mailing Address - Country:US
Mailing Address - Phone:510-703-3015
Mailing Address - Fax:
Practice Address - Street 1:315 S SCHOOL ST
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-6626
Practice Address - Country:US
Practice Address - Phone:510-703-3015
Practice Address - Fax:510-703-3015
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6623225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation