Provider Demographics
NPI:1043788623
Name:MASCHKE, CYNTHIA SUE (OTR)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SUE
Last Name:MASCHKE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:SUE
Other - Last Name:WAITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4701 E HURON RIVER DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9335
Mailing Address - Country:US
Mailing Address - Phone:734-975-2600
Mailing Address - Fax:
Practice Address - Street 1:4701 E HURON RIVER DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9335
Practice Address - Country:US
Practice Address - Phone:734-975-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201002806225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology