Provider Demographics
NPI:1770959884
Name:MAZUR, THAIS (OTR)
Entity type:Individual
Prefix:MS
First Name:THAIS
Middle Name:
Last Name:MAZUR
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 443
Mailing Address - Street 2:
Mailing Address - City:MENDOCINO
Mailing Address - State:CA
Mailing Address - Zip Code:95460-0443
Mailing Address - Country:US
Mailing Address - Phone:808-494-7434
Mailing Address - Fax:
Practice Address - Street 1:17201 OCEAN DR
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-9313
Practice Address - Country:US
Practice Address - Phone:808-494-7434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1266225X00000X
CA986794225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist