Healthcare Provider Details

I. General information

NPI: 1760953053
Provider Name (Legal Business Name): CARRIE HOZESKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 16TH ST STE 7
BAY CITY MI
48708-7609
US

IV. Provider business mailing address

950 BELAIR DR
SAGINAW MI
48638-5809
US

V. Phone/Fax

Practice location:
  • Phone: 989-667-2320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201004309
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: