Provider Demographics
NPI:1013520360
Name:ASIMOS, MARY KATHERINE (MMT, MT-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:ASIMOS
Suffix:
Gender:F
Credentials:MMT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SCOTCH HEATHER
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-4371
Mailing Address - Country:US
Mailing Address - Phone:704-756-1572
Mailing Address - Fax:
Practice Address - Street 1:9 SCOTCH HEATHER
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-4371
Practice Address - Country:US
Practice Address - Phone:704-756-1572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist