Kassandra R Kostock, MSOT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

6675-26 Issued in WI

Practice address

700 Geneva Pkwy N Ste a
Lake Geneva, WI 53147-4594

Phone

(262) 249-3505

NPI assigned

Nov 14, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kassandra R Kanaga Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1573689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636934400000",
    "number": "1073158937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 W FOREST HOME AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532152843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 GENEVA PKWY N STE A",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531474594",
            "telephone_number": "262-249-3505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25250 75th St",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "WI",
            "postal_code": "531688705",
            "country_code": "US",
            "telephone_number": "262-843-4200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOSTOCK",
        "first_name": "KASSANDRA",
        "middle_name": "R",
        "credential": "MSOT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-14",
        "last_updated": "2021-11-15",
        "certification_date": "2021-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "6675-26",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KASSANDRA",
            "last_name": "KANAGA",
            "middle_name": "R",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• James L Knavel, MD
• Jeff D Kohlbeck, D.C.
• R. Andrew Kokodynski
• Britton W Kolar, MD
• Tricia Korth, COTA
• Joy M Kowalski
• Elena Caraman Krause, MD
• Geetha Priydarshini Krishnan, MD
• Kaitlyn Elise Kurth, DPT
• Amanda Kutis, LAT

• Occupational Therapist in Lake Geneva, WI
• Providers in Lake Geneva, WI by specialty
• Occupational Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.