Provider Demographics
NPI:1255932604
Name:MATHIS, CASSIE MAE (CPO)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:MAE
Last Name:MATHIS
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W1643 GREINER RD
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:WI
Mailing Address - Zip Code:54130-7943
Mailing Address - Country:US
Mailing Address - Phone:920-213-3512
Mailing Address - Fax:
Practice Address - Street 1:W1643 GREINER RD
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:WI
Practice Address - Zip Code:54130-7943
Practice Address - Country:US
Practice Address - Phone:920-213-3512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier