Provider Demographics
NPI:1275922296
Name:MAUST, KANDIS (MS, AT)
Entity Type:Individual
Prefix:
First Name:KANDIS
Middle Name:
Last Name:MAUST
Suffix:
Gender:F
Credentials:MS, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 N HAMILTON RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1757
Mailing Address - Country:US
Mailing Address - Phone:614-293-7600
Mailing Address - Fax:
Practice Address - Street 1:920 N HAMILTON RD
Practice Address - Street 2:SUITE 600
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1757
Practice Address - Country:US
Practice Address - Phone:614-293-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0041542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer