Provider Demographics
NPI:1457058703
Name:MANSFIELD, MAYSA LINN
Entity Type:Individual
Prefix:
First Name:MAYSA
Middle Name:LINN
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11235 STATE HIGHWAY 181
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MO
Mailing Address - Zip Code:65760-8285
Mailing Address - Country:US
Mailing Address - Phone:870-736-2002
Mailing Address - Fax:
Practice Address - Street 1:794 PEBBLECREEK DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-5782
Practice Address - Country:US
Practice Address - Phone:870-421-2148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT2023-003225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist