Provider Demographics
NPI:1033008867
Name:CUSI, MARY CATHRINE (OTR)
Entity type:Individual
Prefix:
First Name:MARY CATHRINE
Middle Name:
Last Name:CUSI
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 BRADY DR APT 4
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-7139
Mailing Address - Country:US
Mailing Address - Phone:706-755-5042
Mailing Address - Fax:
Practice Address - Street 1:1300 W WAUGH ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3434
Practice Address - Country:US
Practice Address - Phone:762-226-2287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT14722225XP0019X
GAOT004703225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation