Healthcare Provider Details

I. General information

NPI: 1760081186
Provider Name (Legal Business Name): ELISSA MARIE KUCINSKY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 10/19/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 W 25TH ST UNIT 1
CLEVELAND OH
44113-3184
US

IV. Provider business mailing address

3501 STRATFORD DR
VESTAL NY
13850-2222
US

V. Phone/Fax

Practice location:
  • Phone: 216-685-9975
  • Fax:
Mailing address:
  • Phone: 607-341-8468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT011274
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: