Individual
MARIO ANTLEY KASSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L,
Contact information
Practice address
3200 BREMERTON LN, AURORA, IL 60504-7263
(630) 999-0175
Mailing address
3200 BREMERTON LN, AURORA, IL 60504-7263
(630) 999-0175
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
22860
CA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021005455
MISSOURI DIVISION OF PROFESSIONAL REGISTRATION- OCCUPATIONAL THERAPY
MO
01
—
22860
CALIFORNIA BOARD OF OCCUPATIONAL THERAPY
CA
Enumeration date
02/06/2025
Last updated
02/24/2025
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