MEDICARE: VALERIE LYNN KOCISKO PTA

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	225200000X	Physical Therapy Assistant	PTA08598	OH

General Provider Information

NPI Number	:	1881570570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE LYNN KOCISKO PTA

Provider Business Mailing Address
First Line	:	6099 RIVERSIDE DR STE 207
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-2004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3430 BRUNSWICK LAKE PKWY
Second Line	:
City	:	BRUNSWICK
State	:	OH
Zip	:	44212-3673
Country	:	US
Telephone Number	:	330-460-4244
Fax Number	:

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

Provider Enumeration Date	:	08/15/2025
Last Update Date	:	08/15/2025

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