Provider Demographics
NPI:1023395357
Name:KOZLOSKY, SAMANTHA JO (COTA/L)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:KOZLOSKY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W SAVORY ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3945
Mailing Address - Country:US
Mailing Address - Phone:570-622-7598
Mailing Address - Fax:
Practice Address - Street 1:1000 SCHUYLKILL MANOR RD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3862
Practice Address - Country:US
Practice Address - Phone:570-624-3228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATOP008363224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant