Provider Demographics
NPI:1598135444
Name:CYRULIK, ANTHONY JR (COTA)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:CYRULIK
Suffix:JR
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 MATTABASSETT ST
Mailing Address - Street 2:
Mailing Address - City:EAST BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06023-1114
Mailing Address - Country:US
Mailing Address - Phone:860-707-5369
Mailing Address - Fax:
Practice Address - Street 1:26 MATTABASSETT ST
Practice Address - Street 2:
Practice Address - City:EAST BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06023-1114
Practice Address - Country:US
Practice Address - Phone:860-707-5369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1615224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant