Provider Demographics
NPI:1639567357
Name:KUZELA, RICHARD (COTA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:KUZELA
Suffix:
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:PO BOX 870
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-0870
Mailing Address - Country:US
Mailing Address - Phone:877-312-6576
Mailing Address - Fax:814-506-8213
Practice Address - Street 1:2701 SOUTHAMPTON RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-1205
Practice Address - Country:US
Practice Address - Phone:215-856-2700
Practice Address - Fax:215-856-2777
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007879224Z00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility