Provider Demographics
NPI:1871987362
Name:MASECAMPO, MAYBELLE ANNE DOHERTY (COTA)
Entity type:Individual
Prefix:MS
First Name:MAYBELLE ANNE
Middle Name:DOHERTY
Last Name:MASECAMPO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10007 GIFFORD DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-2722
Mailing Address - Country:US
Mailing Address - Phone:352-263-3008
Mailing Address - Fax:
Practice Address - Street 1:10007 GIFFORD DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-2722
Practice Address - Country:US
Practice Address - Phone:352-263-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCOTA14336224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant