Provider Demographics
NPI:1083765754
Name:CYBULSKI, KERRI J (OT)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:J
Last Name:CYBULSKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:16 LORRAINE DR
Mailing Address - Street 2:
Mailing Address - City:BEACON FALLS
Mailing Address - State:CT
Mailing Address - Zip Code:06403-1256
Mailing Address - Country:US
Mailing Address - Phone:203-490-9581
Mailing Address - Fax:
Practice Address - Street 1:240 COLONY ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5205
Practice Address - Country:US
Practice Address - Phone:203-384-8681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002072225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist