MEDICARE: MS. NICOLE MARIE CUSUMANO OTR L

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	225X00000X	Occupational Therapist	010626-1	NY

General Provider Information

NPI Number	:	1508952938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE MARIE CUSUMANO OTR L

Provider Business Mailing Address
First Line	:	633 W MARKET ST
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-1718
Country	:	US
Telephone Number	:	917-603-6503
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 COURT ST
Second Line	:	9TH FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11201-4859
Country	:	US
Telephone Number	:	718-855-7707
Fax Number	:

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/08/2007

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