Provider Demographics
NPI:1154650463
Name:MCMAHON, SUSAN MARIE
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4719
Mailing Address - Country:US
Mailing Address - Phone:541-752-9649
Mailing Address - Fax:541-753-0559
Practice Address - Street 1:117 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4719
Practice Address - Country:US
Practice Address - Phone:541-752-9649
Practice Address - Fax:541-753-0559
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2011-12-20
Deactivation Date:2010-01-05
Deactivation Code:
Reactivation Date:2011-12-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter