Provider Demographics
NPI:1336756006
Name:COUSAR, TAKIYA (BS)
Entity type:Individual
Prefix:
First Name:TAKIYA
Middle Name:
Last Name:COUSAR
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 WATKINS ST APT A5
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-5268
Mailing Address - Country:US
Mailing Address - Phone:570-994-6099
Mailing Address - Fax:
Practice Address - Street 1:3764 EASTON NAZARETH HWY # 1071
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-8340
Practice Address - Country:US
Practice Address - Phone:484-202-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program