Provider Demographics
NPI:1043727969
Name:KABUSK, LINDSAY E
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:E
Last Name:KABUSK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:E
Other - Last Name:BOSTICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:441 LATONA AVE
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-2715
Mailing Address - Country:US
Mailing Address - Phone:724-263-1875
Mailing Address - Fax:
Practice Address - Street 1:441 LATONA AVE
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-2715
Practice Address - Country:US
Practice Address - Phone:724-263-1875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-30
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0005228225X00000X
WAOT60841597225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist