Provider Demographics
NPI:1215631072
Name:HALL, CASSANDRA LYNNE (COTA)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LYNNE
Last Name:HALL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:BENNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6181 WISE RD
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:CA
Mailing Address - Zip Code:95658-9231
Mailing Address - Country:US
Mailing Address - Phone:916-300-0298
Mailing Address - Fax:
Practice Address - Street 1:4987 GOLDEN FOOTHILL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9364
Practice Address - Country:US
Practice Address - Phone:916-365-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6101224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant