Provider Demographics
NPI:1306447719
Name:SHUSMAN, MAXINE SYDNEY
Entity type:Individual
Prefix:
First Name:MAXINE
Middle Name:SYDNEY
Last Name:SHUSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 VALLEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-2029
Mailing Address - Country:US
Mailing Address - Phone:610-247-0665
Mailing Address - Fax:
Practice Address - Street 1:238 VALLEY RIDGE RD
Practice Address - Street 2:
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-2029
Practice Address - Country:US
Practice Address - Phone:610-247-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC000548L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist