Provider Demographics
NPI:1699202788
Name:KUSMER, EMILY HELEN
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:HELEN
Last Name:KUSMER
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 1:803 BIRCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-2940
Mailing Address - Country:US
Mailing Address - Phone:419-890-7677
Mailing Address - Fax:
Practice Address - Street 1:3101 W US ROUTE 224
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883
Practice Address - Country:US
Practice Address - Phone:419-448-0220
Practice Address - Fax:419-443-1691
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT016863225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist