Provider Demographics
NPI:1043266612
Name:COSTEA, LUCIANA DRAGOMIRA (MS, OTR)
Entity Type:Individual
Prefix:MS
First Name:LUCIANA
Middle Name:DRAGOMIRA
Last Name:COSTEA
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1622
Mailing Address - Country:US
Mailing Address - Phone:269-501-6722
Mailing Address - Fax:269-978-8283
Practice Address - Street 1:5749 STADIUM DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1946
Practice Address - Country:US
Practice Address - Phone:269-873-3000
Practice Address - Fax:269-978-8283
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003557225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist