Provider Demographics
NPI:1407013469
Name:MASUS, MARY CHRISTINE (DT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CHRISTINE
Last Name:MASUS
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 KINNE CIR
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-4556
Mailing Address - Country:US
Mailing Address - Phone:630-406-0825
Mailing Address - Fax:
Practice Address - Street 1:1175 KINNE CIRCLE
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-4556
Practice Address - Country:US
Practice Address - Phone:630-406-0825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist