Provider Demographics
NPI:1679887608
Name:SKURKA, CAREN (OTR)
Entity Type:Individual
Prefix:
First Name:CAREN
Middle Name:
Last Name:SKURKA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 ACRES OF PINE RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-8949
Mailing Address - Country:US
Mailing Address - Phone:401-397-2761
Mailing Address - Fax:
Practice Address - Street 1:38 ACRES OF PINE RD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-8949
Practice Address - Country:US
Practice Address - Phone:401-397-2761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT00778174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI050512037OtherTHE AUTISM PROJECT