Provider Demographics
NPI:1376135475
Name:KOSCIELNY, CYNTHIA (COTA, LMT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:KOSCIELNY
Suffix:
Gender:F
Credentials:COTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2342 CHAUCER ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-4203
Mailing Address - Country:US
Mailing Address - Phone:727-400-4988
Mailing Address - Fax:
Practice Address - Street 1:7101 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-5819
Practice Address - Country:US
Practice Address - Phone:727-527-7231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA17979224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant