MEDICARE: BRIAN M CELUSNAK CVRT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225400000X	Rehabilitation Practitioner
2	2255R0406X	Blind Rehabilitation Specialist/Technologist
3	225CA2400X	Assistive Technology Practitioner Rehabilitation Counselor

General Provider Information

NPI Number	:	1962827873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN M CELUSNAK CVRT

Provider Business Mailing Address
First Line	:	30 SEVERANCE CIR
Second Line	:	APT. 705
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1531
Country	:	US
Telephone Number	:	248-568-6570
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 SEVERANCE CIR
Second Line	:	APT. 705
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1531
Country	:	US
Telephone Number	:	248-568-6570
Fax Number	:

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

Provider Enumeration Date	:	02/28/2014
Last Update Date	:	05/01/2014

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