Provider Demographics
NPI:1871886580
Name:KRZECZKOWSKI, PAULA MARY (OTR)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:MARY
Last Name:KRZECZKOWSKI
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 RED CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-3764
Mailing Address - Country:US
Mailing Address - Phone:248-366-3274
Mailing Address - Fax:
Practice Address - Street 1:1985 W BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3421
Practice Address - Country:US
Practice Address - Phone:248-649-4193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI327122225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist