Provider Demographics
NPI:1316284789
Name:ESSKUCHEN, KAYLIN LAURA (LMT)
Entity type:Individual
Prefix:
First Name:KAYLIN
Middle Name:LAURA
Last Name:ESSKUCHEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 OLD CRITTENDEN RD
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-8510
Mailing Address - Country:US
Mailing Address - Phone:716-531-0175
Mailing Address - Fax:
Practice Address - Street 1:1364 UNION RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2919
Practice Address - Country:US
Practice Address - Phone:716-531-0175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-05
Last Update Date:2013-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026540225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist