Provider Demographics
NPI:1760081186
Name:KUCINSKY, ELISSA MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:MARIE
Last Name:KUCINSKY
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 1:3501 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2222
Mailing Address - Country:US
Mailing Address - Phone:607-341-8468
Mailing Address - Fax:
Practice Address - Street 1:1810 W 25TH ST UNIT 1
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3184
Practice Address - Country:US
Practice Address - Phone:216-685-9975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT011274225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation