Provider Demographics
NPI:1710663455
Name:SEDUNOV, KYLIE NICOLE (COTA/L)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:NICOLE
Last Name:SEDUNOV
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:NICOLE
Other - Last Name:STELIGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:900 PAINTER ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:15697-1034
Mailing Address - Country:US
Mailing Address - Phone:724-600-9227
Mailing Address - Fax:
Practice Address - Street 1:6 GARDEN CENTER DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-1351
Practice Address - Country:US
Practice Address - Phone:724-832-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP009617224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant