Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JESSE KUSMULYANA, PTA
ActiveJESSE KUSMULYANA, PTA is a Occupational Therapist healthcare provider located in PERIDOT, Arizona. NPI 1467010082 is currently active in the NPPES registry. Verify at CMS.
Occupational Therapist · PERIDOT, AZ
Registration Details
- NPI Number
- 1467010082
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- May 29, 2019 (7.204117497793 yrs)
- Last Updated
- May 29, 2019
- License
-
PTA-013887 (AZ)
Practice Information
- Address
-
103 MEDICINE WAY RDPERIDOT, AZ, 855425000Browse AZ providers · Browse ZIP 85542
- Phone
- 9284751360
- Primary Specialty
-
Occupational Therapist
225200000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.