MEDICARE: DR. KYLIE ANDREA CASSOTTA OTD, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	28723	CA

General Provider Information

NPI Number	:	1801741947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLIE ANDREA CASSOTTA OTD, OTR/L

Provider Business Mailing Address
First Line	:	17491 MASHIE CIR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-6209
Country	:	US
Telephone Number	:	714-421-8713
Fax Number	:

Provider Business Practice Location Address
First Line	:	3840 WOODRUFF AVE STE 211
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2149
Country	:	US
Telephone Number	:	562-507-1568
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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