Provider Demographics
NPI:1255849923
Name:KUCHINSKI, NICOLE M (LMT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:KUCHINSKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16659 VETERANS MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-8037
Mailing Address - Country:US
Mailing Address - Phone:304-288-0629
Mailing Address - Fax:
Practice Address - Street 1:160 FAYETTE ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-0188
Practice Address - Country:US
Practice Address - Phone:304-288-0629
Practice Address - Fax:304-288-0629
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2018-3577225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2018-3577OtherPEIA
WV2018-3577OtherWC
WV2018-3577OtherHUMANA
WV2018-3577OtherPIP