Provider Demographics
NPI:1659402493
Name:CUSUMANO, SAVERIO (OT)
Entity Type:Individual
Prefix:
First Name:SAVERIO
Middle Name:
Last Name:CUSUMANO
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 SW 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2928
Mailing Address - Country:US
Mailing Address - Phone:786-218-3106
Mailing Address - Fax:305-261-9557
Practice Address - Street 1:326 SW 66TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2928
Practice Address - Country:US
Practice Address - Phone:786-218-3106
Practice Address - Fax:305-261-9557
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT7386225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT7386OtherSTATE LICENSE
FLE6721ZMedicare PIN
FLOT7386OtherSTATE LICENSE