Basic Information
| Provider Information | |||||||||
| NPI: | 1033548425 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCUSKER | ||||||||
| FirstName: | CAITLIN | ||||||||
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| Credential: | M.S.OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 MADISON ST | ||||||||
| Address2: | |||||||||
| City: | GRANVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128321221 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 17 MADISON ST | ||||||||
| Address2: | |||||||||
| City: | GRANVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128321221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105254000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2013 | ||||||||
| LastUpdateDate: | 11/05/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.