Healthcare Provider Details

I. General information

NPI: 1043891393
Provider Name (Legal Business Name): CASSANDRA MAXINE MACHIA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 14TH ST UNIT B
SANTA MONICA CA
90404-4605
US

IV. Provider business mailing address

14358 MAGNOLIA BLVD APT 309
SHERMAN OAKS CA
91423-1063
US

V. Phone/Fax

Practice location:
  • Phone: 310-344-2276
  • Fax:
Mailing address:
  • Phone: 802-730-5040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number22251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: