Provider Demographics
NPI:1710225768
Name:ZUKOSKY, JACQUELINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:ZUKOSKY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 DUG RD
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-9378
Mailing Address - Country:US
Mailing Address - Phone:570-696-1811
Mailing Address - Fax:
Practice Address - Street 1:111 DUG RD
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644-9378
Practice Address - Country:US
Practice Address - Phone:570-696-1811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC001750L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist