MEDICARE: KASSADI EHL

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	106S00000X	Behavior Technician
2	106E00000X	Assistant Behavior Analyst	0-26-16969	OK
3	106S00000X	Behavior Technician	23-287422	OK

General Provider Information

NPI Number	:	1710669338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASSADI EHL

Provider Business Mailing Address
First Line	:	3635 NW 39TH EXPRESSWAY
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-6309
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3635 NW 39TH EXPRESSWAY
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-6309
Country	:	US
Telephone Number	:	405-857-8280
Fax Number	:

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

Provider Enumeration Date	:	08/03/2023
Last Update Date	:	03/05/2026

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Directions to “ KASSADI EHL ” Practice Location

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