Healthcare Provider Details

I. General information

NPI: 1881570570
Provider Name (Legal Business Name): VALERIE LYNN KOCISKO PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 BRUNSWICK LAKE PKWY
BRUNSWICK OH
44212-3673
US

IV. Provider business mailing address

6099 RIVERSIDE DR STE 207
DUBLIN OH
43017-2004
US

V. Phone/Fax

Practice location:
  • Phone: 330-460-4244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA08598
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: