Individual
MRS. JUDITH SUSAN MYSTKOWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
290 NORWOOD AVE, PORT JEFFERSON STATION, NY 11776-2562
(631) 474-8130
Mailing address
170 HUBER AVE, HOLBROOK, NY 11741-3217
(631) 553-2522
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
008322-01
NY
Other
Enumeration date
08/18/2022
Last updated
08/18/2022
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