Provider Demographics
NPI:1386974822
Name:TUSICK, JENNIFER KATHLEEN (COTA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KATHLEEN
Last Name:TUSICK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KATHLEEN
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 LOCUST ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-3954
Mailing Address - Country:US
Mailing Address - Phone:412-299-0704
Mailing Address - Fax:412-299-2823
Practice Address - Street 1:401 LOCUST ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-3954
Practice Address - Country:US
Practice Address - Phone:412-299-0704
Practice Address - Fax:412-299-2823
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATOP008118224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant