Provider Demographics
NPI:1336525526
Name:KOSCIUK, ELLE (ATC)
Entity Type:Individual
Prefix:
First Name:ELLE
Middle Name:
Last Name:KOSCIUK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 MISTLETOE LN
Mailing Address - Street 2:
Mailing Address - City:WINNECONNE
Mailing Address - State:WI
Mailing Address - Zip Code:54986-9625
Mailing Address - Country:US
Mailing Address - Phone:920-573-9627
Mailing Address - Fax:
Practice Address - Street 1:309 N BARTLETT ST
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-2127
Practice Address - Country:US
Practice Address - Phone:715-526-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer