Provider Demographics
NPI:1336398759
Name:MASTERSON, CARYN M (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CARYN
Middle Name:M
Last Name:MASTERSON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 MARGARET CURTIS LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445-1586
Mailing Address - Country:US
Mailing Address - Phone:708-385-0425
Mailing Address - Fax:
Practice Address - Street 1:5105 MARGARET CURTIS LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:IL
Practice Address - Zip Code:60445-1586
Practice Address - Country:US
Practice Address - Phone:708-385-0425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056002589174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL056002589OtherDEPARTMENT OF PROFESSIONAL REGULATION REGISTERED OCCUPATIONAL THERAPIST