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General NPI Number Information
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NPI Number | 1073795845
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Entity Type | Individual
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Provider Name | MARYANNE RAKIDZIOSKI M.O.T
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Gender | Female
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 5201 CONNER ST
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City | DETROIT
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State | MI
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Zip | 48213-3405
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Country | US
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Telephone | 773-595-6277
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Fax |
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Provider Business Mailing Address
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Address Line | 1328 CARRIAGE LANE
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City | WINDSOR
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State | ONTARIO
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Zip | N9H1Z9
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Country | CA
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Telephone | 773-595-6277
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5201007169
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 12818
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056.008476
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT9687
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License Number State | CA
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