Healthcare Provider Details

I. General information

NPI: 1881748770
Provider Name (Legal Business Name): DENISE KASSARJIAN BS OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 ORLEANS RD
NORTH CHATHAM MA
02650-1154
US

IV. Provider business mailing address

104 GRASSY POND DR E
DENNIS MA
02638-2512
US

V. Phone/Fax

Practice location:
  • Phone: 508-945-9611
  • Fax: 508-945-9603
Mailing address:
  • Phone: 508-385-5241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number68OT
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: