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General NPI Number Information
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NPI Number | 1033008867
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Entity Type | Individual
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Provider Name | MARY CATHRINE CUSI OTR
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Gender | Female
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Dates
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Enumeration Date | 06/27/2025
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 1300 W WAUGH ST
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City | DALTON
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State | GA
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Zip | 30720-3434
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Country | US
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Telephone | 762-226-2287
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Fax |
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Provider Business Mailing Address
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Address Line | 1907 BRADY DR APT 4
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City | DALTON
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State | GA
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Zip | 30720-7139
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Country | US
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Telephone | 706-755-5042
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | OT14722
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT004703
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License Number State | GA
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