Basic Information
| Provider Information | |||||||||
| NPI: | 1790916526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MASTERSON | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | BREWER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 170 MILL ST | ||||||||
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| City: | GAHANNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432303036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144145437 | ||||||||
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| Address1: | 170 MILL ST | ||||||||
| Address2: | |||||||||
| City: | GAHANNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432303036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144145437 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2009 | ||||||||
| LastUpdateDate: | 07/28/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 007335 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.