Provider Demographics
NPI:1033934336
Name:THELUSCA, MANICA
Entity type:Individual
Prefix:
First Name:MANICA
Middle Name:
Last Name:THELUSCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1A ROSAMOND ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4815
Mailing Address - Country:US
Mailing Address - Phone:857-312-0620
Mailing Address - Fax:
Practice Address - Street 1:239 MILL ST STE B335
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-3191
Practice Address - Country:US
Practice Address - Phone:508-752-8466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist