MEDICARE: KASSAUNDRE SANTAYANA 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		NY

General Provider Information

NPI Number	:	1538710694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASSAUNDRE SANTAYANA OTR/L

Provider Business Mailing Address
First Line	:	605 PARK AVE APT 12B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-7018
Country	:	US
Telephone Number	:	212-858-9309
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 PARK AVE APT 12B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-7018
Country	:	US
Telephone Number	:	212-858-9309
Fax Number	:

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

Provider Enumeration Date	:	09/20/2019
Last Update Date	:	09/20/2019

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