Provider Demographics
NPI:1508034422
Name:KUS, CAROLYN MARY (OTR)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:MARY
Last Name:KUS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1947 FIRCREST AVE
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-9647
Mailing Address - Country:US
Mailing Address - Phone:360-678-1273
Mailing Address - Fax:
Practice Address - Street 1:1947 FIRCREST AVE
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-9647
Practice Address - Country:US
Practice Address - Phone:360-678-1273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00000467225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation