Provider Demographics
NPI:1235550021
Name:KOCHMANSKI, ELYSE (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:ELYSE
Middle Name:
Last Name:KOCHMANSKI
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 WARD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-1711
Mailing Address - Country:US
Mailing Address - Phone:716-243-2776
Mailing Address - Fax:
Practice Address - Street 1:521 WARD RD
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-1711
Practice Address - Country:US
Practice Address - Phone:716-243-2776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10022225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist