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General NPI Number Information
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NPI Number | 1790497675
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Entity Type | Individual
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Provider Name | LEA ANN CUSANO
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Gender | Female
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Dates
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Enumeration Date | 12/22/2022
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Last Update Date | 12/22/2022
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Provider Practice Location Address
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Address Line | 4988 STATE HIGHWAY 30
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City | AMSTERDAM
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State | NY
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Zip | 12010-7520
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Country | US
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Telephone | 518-841-3571
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Fax |
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Provider Business Mailing Address
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Address Line | 17 SOCHA LN
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City | SCHENECTADY
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State | NY
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Zip | 12302-3818
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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