Provider Demographics
NPI:1184844060
Name:CUSIMANO, KARIN ANDREA (OTR)
Entity type:Individual
Prefix:MRS
First Name:KARIN
Middle Name:ANDREA
Last Name:CUSIMANO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:27963 SANTA ANITA DR S
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-4883
Mailing Address - Country:US
Mailing Address - Phone:586-598-1482
Mailing Address - Fax:586-598-1482
Practice Address - Street 1:43533 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-1034
Practice Address - Country:US
Practice Address - Phone:586-469-5613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201005303225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist