Healthcare Provider Details

I. General information

NPI: 1891427241
Provider Name (Legal Business Name): EWA MARIA ZYLINSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2022
Last Update Date: 06/25/2022
Certification Date: 06/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 TOWN CENTER DR
TROY MI
48084-1774
US

IV. Provider business mailing address

16943 HARRISON ST
LIVONIA MI
48154-3417
US

V. Phone/Fax

Practice location:
  • Phone: 248-643-8900
  • Fax: 248-740-3505
Mailing address:
  • Phone: 313-550-7043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5202007317
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: