MEDICARE: SASSAFRAS THERAPY LLC

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

General Provider Information

NPI Number	:	1720703622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SASSAFRAS THERAPY LLC

Provider Business Mailing Address
First Line	:	1350 PARK DR STE B
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3205
Country	:	US
Telephone Number	:	985-869-3650
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 PARK DR STE B
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3205
Country	:	US
Telephone Number	:	985-869-3650
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, OCCUPATIONAL THERAPIST
Name	:	KATHERINE GRISTINA
Credential	:	MS, LOTR
Telephone Number	:	985-869-3650

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	10/06/2022

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