MEDICARE: KATHLEEN MASTERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1720324585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN MASTERSON

Provider Business Mailing Address
First Line	:	3714 SW 12TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-5115
Country	:	US
Telephone Number	:	239-220-0720
Fax Number	:	239-220-5525

Provider Business Practice Location Address
First Line	:	3714 SW 12TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-5115
Country	:	US
Telephone Number	:	239-220-0720
Fax Number	:	239-220-5525

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2012
Last Update Date	:	01/25/2013

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Directions to “ KATHLEEN MASTERSON ” Practice Location

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