Provider Demographics
NPI:1104916972
Name:LACZKOSKIE, MARIA PHILOMENA (MSOTR/L)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:PHILOMENA
Last Name:LACZKOSKIE
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3995 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2773
Mailing Address - Country:US
Mailing Address - Phone:717-757-1227
Mailing Address - Fax:
Practice Address - Street 1:3995 E MARKET ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-2773
Practice Address - Country:US
Practice Address - Phone:717-757-1227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008707225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019562420005Medicaid