MEDICARE: ELISSA MARIE KUCINSKY OTR/L

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	225XP0019X	Physical Rehabilitation Occupational Therapist	OT011274	OH

General Provider Information

NPI Number	:	1760081186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISSA MARIE KUCINSKY OTR/L

Provider Business Mailing Address
First Line	:	3501 STRATFORD DR
Second Line	:
City	:	VESTAL
State	:	NY
Zip	:	13850-2222
Country	:	US
Telephone Number	:	607-341-8468
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 ROCKSIDE RD
Second Line	:
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2172
Country	:	US
Telephone Number	:	216-986-4000
Fax Number	:

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

Provider Enumeration Date	:	10/19/2020
Last Update Date	:	05/15/2026

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