Provider Demographics
NPI:1487840526
Name:KUSCH, JENNIFER P (ATC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:P
Last Name:KUSCH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 GEORGIAN RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-2110
Mailing Address - Country:US
Mailing Address - Phone:781-642-8350
Mailing Address - Fax:
Practice Address - Street 1:45 GEORGIAN RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-2110
Practice Address - Country:US
Practice Address - Phone:781-642-8350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-22
Last Update Date:2007-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer