Healthcare Provider Details

I. General information

NPI: 1437250842
Provider Name (Legal Business Name): MISS CANDIDA KATHRYN MAUST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAMEDDAC WUERZBURG EDIS CLINIC ANSBACH 235TH BSB UNIT 28614
APO AE
09177
US

IV. Provider business mailing address

USAMEDDAC WUERZBURG ATTN: CREDENTIALS OFFICE UNIT 26610
APO AE
09244
US

V. Phone/Fax

Practice location:
  • Phone: 011490981183811
  • Fax: 011490981183854
Mailing address:
  • Phone: 011499318043616
  • Fax: 011499318043241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT10733
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: