Provider Demographics
NPI:1033792650
Name:KUSHNIRSKY, SIMONE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:KUSHNIRSKY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4278 DESTE CT APT 308
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-4143
Mailing Address - Country:US
Mailing Address - Phone:781-724-4357
Mailing Address - Fax:
Practice Address - Street 1:4278 DESTE CT APT 308
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-4143
Practice Address - Country:US
Practice Address - Phone:781-724-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-02
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist