Healthcare Provider Details

I. General information

NPI: 1710669338
Provider Name (Legal Business Name): KASSADI EHL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 MAGNOLIA CT
MOORE OK
73160-1397
US

IV. Provider business mailing address

4817 LIMESTONE DR
OKLAHOMA CITY OK
73179-4823
US

V. Phone/Fax

Practice location:
  • Phone: 479-318-2300
  • Fax:
Mailing address:
  • Phone: 479-318-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-16969
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number23-287422
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: