Provider Demographics
NPI:1184044307
Name:KUKULSKI, PATRICIA (COTA/L)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:KUKULSKI
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 1:165 S BLOOMINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1434
Mailing Address - Country:US
Mailing Address - Phone:630-980-8700
Mailing Address - Fax:
Practice Address - Street 1:165 S BLOOMINGDALE RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1434
Practice Address - Country:US
Practice Address - Phone:630-980-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-27
Last Update Date:2014-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.003598224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant