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NPI Code Detail

MEDICARE: MISS MARYANNE RAKIDZIOSKI M.O.T

MEDICARE: MISS MARYANNE RAKIDZIOSKI M.O.T
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist5201007169MI
2225X00000XOccupational Therapist12818FL
3225X00000XOccupational Therapist056.008476IL
4225X00000XOccupational TherapistOT9687CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073795845
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS MARYANNE RAKIDZIOSKI M.O.T
Provider Business Mailing Address
First Line : 1328 CARRIAGE LANE
Second Line :
City : WINDSOR
State : ONTARIO
Zip : N9H1Z9
Country : CA
Telephone Number : 773-595-6277
Fax Number :
Provider Business Practice Location Address
First Line : 5201 CONNER ST
Second Line :
City : DETROIT
State : MI
Zip : 48213-3405
Country : US
Telephone Number : 773-595-6277
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2007
Last Update Date : 10/24/2024

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