Provider Demographics
NPI:1730781899
Name:CHRUSCICKI, AMANDA ROSE JUDE (OT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSE JUDE
Last Name:CHRUSCICKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5176 STATE ROUTE 233
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND
Mailing Address - State:NY
Mailing Address - Zip Code:13490-1310
Mailing Address - Country:US
Mailing Address - Phone:315-557-2637
Mailing Address - Fax:
Practice Address - Street 1:5176 STATE ROUTE 233
Practice Address - Street 2:
Practice Address - City:WESTMORELAND
Practice Address - State:NY
Practice Address - Zip Code:13490-1310
Practice Address - Country:US
Practice Address - Phone:315-557-2637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025361225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist