Individual
PHILIP MICHAEL CUSACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
1871 NE STEPHENS ST, ROSEBURG, OR 97470-1433
(541) 440-4794
Mailing address
1440 BYRON CREEK RD, WINSTON, OR 97496-4542
(541) 673-0609
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
986755
OR
Other
Enumeration date
02/07/2024
Last updated
02/07/2024
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