MEDICARE: DAVID KASYNAK

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
1	101200000X	Drama Therapist

General Provider Information

NPI Number	:	1538738224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID KASYNAK

Provider Business Mailing Address
First Line	:	2980 NW 43RD TER
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-1942
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2980 NW 43RD TER
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-1942
Country	:	US
Telephone Number	:	347-622-8288
Fax Number	:

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

Provider Enumeration Date	:	06/17/2021
Last Update Date	:	06/17/2021

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