Provider Demographics
NPI:1952649295
Name:MANCUSO, LINDA (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:MANCUSO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-7002
Mailing Address - Country:US
Mailing Address - Phone:413-539-6910
Mailing Address - Fax:413-539-6840
Practice Address - Street 1:110 CHERRY ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-7002
Practice Address - Country:US
Practice Address - Phone:413-539-6910
Practice Address - Fax:413-539-6840
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2693224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant