Provider Demographics
NPI:1942490347
Name:DACIUK, BARBARA (COTA)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:
Last Name:DACIUK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:INNOCENTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:27 AUGUSTA RD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-2237
Mailing Address - Country:US
Mailing Address - Phone:732-849-5063
Mailing Address - Fax:
Practice Address - Street 1:220 WHITE PLAINS RD
Practice Address - Street 2:SUITE 550
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5837
Practice Address - Country:US
Practice Address - Phone:914-631-9020
Practice Address - Fax:914-631-9028
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09020700224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant