Provider Demographics
NPI:1346585205
Name:KRUSZKA, ROSE MARIA
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:MARIA
Last Name:KRUSZKA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ROSE
Other - Middle Name:MARIA
Other - Last Name:NAPPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:10714 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14129-9746
Mailing Address - Country:US
Mailing Address - Phone:716-532-1049
Mailing Address - Fax:716-532-0679
Practice Address - Street 1:10714 NORTH RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:NY
Practice Address - Zip Code:14129-9746
Practice Address - Country:US
Practice Address - Phone:716-532-1049
Practice Address - Fax:716-532-0679
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002492-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant