Provider Demographics
NPI:1508296823
Name:KUSTRA, MARIA (COTA/L)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:KUSTRA
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 1:3811 GROVER ST FRNT
Mailing Address - Street 2:
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132-5620
Mailing Address - Country:US
Mailing Address - Phone:412-401-2510
Mailing Address - Fax:
Practice Address - Street 1:2600 W RUN RD
Practice Address - Street 2:
Practice Address - City:MUNHALL
Practice Address - State:PA
Practice Address - Zip Code:15120-2869
Practice Address - Country:US
Practice Address - Phone:412-462-8002
Practice Address - Fax:412-462-2113
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006712224Z00000X
224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant