Active NPI
Mario Antley Kassa, OTR/L,
- Student in an Organized Health Care Education/Training Program
- Aurora, IL
National Provider Identifier
1689488744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 3200 Bremerton LN
Aurora, IL 60504-7263 - Phone
- (630) 999-0175
- NPI assigned
- Feb 6, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 22860 | CA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | UT | Primary |
Addresses
Primary practice location
3200 Bremerton LN
Aurora, IL 60504-7263
Mailing address
3200 Bremerton LN
Aurora, IL 60504-7263
Phone (630) 999-0175
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22860 | Other | CA | CALIFORNIA BOARD OF OCCUPATIONAL THERAPY |
| 2021005455 | Other | MO | MISSOURI DIVISION OF PROFESSIONAL REGISTRATION- OCCUPATIONAL THERAPY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22860 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1738800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740355200000",
"number": "1689488744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3200 BREMERTON LN",
"city": "AURORA",
"state": "IL",
"postal_code": "605047263",
"telephone_number": "630-999-0175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 BREMERTON LN",
"city": "AURORA",
"state": "IL",
"postal_code": "605047263",
"telephone_number": "630-999-0175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KASSA",
"first_name": "MARIO",
"middle_name": "ANTLEY",
"credential": "OTR/L,",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-02-06",
"last_updated": "2025-02-24",
"certification_date": "2025-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "22860",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "UT",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIFORNIA BOARD OF OCCUPATIONAL THERAPY",
"identifier": "22860",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MISSOURI DIVISION OF PROFESSIONAL REGISTRATION- OCCUPATIONAL THERAPY",
"identifier": "2021005455",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Aurora, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.