Provider Demographics
NPI:1821583345
Name:MASCOLA, KATHY L (CO, BOCPO, LPO)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:MASCOLA
Suffix:
Gender:F
Credentials:CO, BOCPO, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5703
Mailing Address - Country:US
Mailing Address - Phone:973-736-2244
Mailing Address - Fax:973-736-2227
Practice Address - Street 1:331 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5703
Practice Address - Country:US
Practice Address - Phone:973-736-2244
Practice Address - Fax:973-736-2227
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO00009500222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist