Provider Demographics
NPI:1598316549
Name:KUTSKO, LUCINDA LOIS
Entity Type:Individual
Prefix:MRS
First Name:LUCINDA
Middle Name:LOIS
Last Name:KUTSKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11105 N PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:NORTH JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:44451-9725
Mailing Address - Country:US
Mailing Address - Phone:330-727-4477
Mailing Address - Fax:
Practice Address - Street 1:11105 N PALMYRA RD
Practice Address - Street 2:
Practice Address - City:NORTH JACKSON
Practice Address - State:OH
Practice Address - Zip Code:44451-9725
Practice Address - Country:US
Practice Address - Phone:330-727-4477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer