Provider Demographics
NPI:1164029328
Name:BLUNKOSKY, MADISON
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:BLUNKOSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:KIRAGIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4944 SIMMONS CIR
Mailing Address - Street 2:
Mailing Address - City:EXPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15632-9330
Mailing Address - Country:US
Mailing Address - Phone:412-953-4799
Mailing Address - Fax:
Practice Address - Street 1:1405 SHADY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1350
Practice Address - Country:US
Practice Address - Phone:412-420-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATOC103656225X00000X
PAOC018290225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist