MEDICARE: TRISTAN JAROSIEWICZ OTR/L

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
1	225X00000X	Occupational Therapist	5201012658	MI

General Provider Information

NPI Number	:	1841953296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISTAN JAROSIEWICZ OTR/L

Provider Business Mailing Address
First Line	:	38629 FLORENCE ST
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48185-8802
Country	:	US
Telephone Number	:	734-659-7344
Fax Number	:

Provider Business Practice Location Address
First Line	:	2102 ORLEANS ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-2769
Country	:	US
Telephone Number	:	313-462-4362
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2021
Last Update Date	:	10/21/2021

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