Provider Demographics
NPI:1720324585
Name:MASTERSON, KATHLEEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MASTERSON
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 1:3714 SW 12TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-5115
Mailing Address - Country:US
Mailing Address - Phone:239-220-0720
Mailing Address - Fax:239-220-5525
Practice Address - Street 1:3714 SW 12TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-5115
Practice Address - Country:US
Practice Address - Phone:239-220-0720
Practice Address - Fax:239-220-5525
Is Sole Proprietor?:No
Enumeration Date:2012-12-26
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor