Provider Demographics
NPI:1346768454
Name:MAZUROSKI, KATHLEEN ROSE (MOTRL)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ROSE
Last Name:MAZUROSKI
Suffix:
Gender:F
Credentials:MOTRL
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ROSE
Other - Last Name:MILLIKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 TEAL POINT DR
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8393
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:83 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:WISCASSET
Practice Address - State:ME
Practice Address - Zip Code:04578-4004
Practice Address - Country:US
Practice Address - Phone:207-882-7767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3292225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty