Provider Demographics
NPI:1568193423
Name:SKROK, JOSCELINE (COTA)
Entity Type:Individual
Prefix:
First Name:JOSCELINE
Middle Name:
Last Name:SKROK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259H TICKLE RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-4754
Mailing Address - Country:US
Mailing Address - Phone:862-212-2248
Mailing Address - Fax:
Practice Address - Street 1:71 CENTER ST
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-3822
Practice Address - Country:US
Practice Address - Phone:508-999-4561
Practice Address - Fax:508-997-0254
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4783224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant