Healthcare Provider Details

I. General information

NPI: 1821877705
Provider Name (Legal Business Name): JUSTIN ERIC KASSNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5589 OKEECHOBEE BLVD
WEST PALM BEACH FL
33417-4486
US

IV. Provider business mailing address

930 MILLBRAE CT UNIT 5
WEST PALM BEACH FL
33401-8474
US

V. Phone/Fax

Practice location:
  • Phone: 561-406-9118
  • Fax:
Mailing address:
  • Phone: 305-788-2792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: