Provider Demographics
NPI:1659158830
Name:SKURKA, ELYSE GAIL
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:GAIL
Last Name:SKURKA
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 1:96 FAIRHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-4709
Mailing Address - Country:US
Mailing Address - Phone:401-486-3934
Mailing Address - Fax:
Practice Address - Street 1:60 HIGH SCHOOL ST
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3034
Practice Address - Country:US
Practice Address - Phone:401-767-4855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI01127225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist