Healthcare Provider Details

I. General information

NPI: 1114225133
Provider Name (Legal Business Name): MRS. KRISTY DUKARSKI ZAGATA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTY DUKARSKI ZAGATA OTRL

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2694 FRASER RD
KAWKAWLIN MI
48631-9115
US

IV. Provider business mailing address

2694 FRASER RD
KAWKAWLIN MI
48631-9115
US

V. Phone/Fax

Practice location:
  • Phone: 989-450-5057
  • Fax:
Mailing address:
  • Phone: 989-450-5057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201004083
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: