Provider Demographics
NPI:1881106334
Name:MONGE, KASSANDRA ELENA (COTA/L)
Entity type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:ELENA
Last Name:MONGE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 POMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1813
Mailing Address - Country:US
Mailing Address - Phone:855-465-7626
Mailing Address - Fax:973-433-0733
Practice Address - Street 1:408 POMPTON AVE
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1813
Practice Address - Country:US
Practice Address - Phone:855-465-7626
Practice Address - Fax:973-433-0733
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09151500224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant