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NPI Code Detail

MEDICARE: MS. CARLY KUKISH MOT

MEDICARE: MS. CARLY KUKISH MOT
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
1225X00000XOccupational Therapist056.011736IL

General Provider Information

NPI Number : 1124448642
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CARLY KUKISH MOT
Provider Business Mailing Address
First Line : 1937 W DIVERSEY PKWY APT 2E
Second Line :
City : CHICAGO
State : IL
Zip : 60614-7844
Country : US
Telephone Number : 215-896-4087
Fax Number :
Provider Business Practice Location Address
First Line : 929 W FOSTER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-1491
Country : US
Telephone Number : 773-433-1800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2014
Last Update Date : 11/03/2016

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