Basic Information
| Provider Information | |||||||||
| NPI: | 1205127388 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASUR MARCHESE | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | MASUR | ||||||||
| NamePrefix: | MRS. | ||||||||
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| OtherLastName: | MASUR | ||||||||
| OtherFirstName: | SUSAN | ||||||||
| OtherMiddleName: | MALEA | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | COTA/L | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2432 LYNNBROOK AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152261658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129567175 | ||||||||
| FaxNumber: | 4123440649 | ||||||||
| Practice Location | |||||||||
| Address1: | 3590 WASHINGTON PIKE | ||||||||
| Address2: | |||||||||
| City: | BRIDGEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150171047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122572474 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2011 | ||||||||
| LastUpdateDate: | 04/25/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OP002623L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.