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General NPI Number Information
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NPI Number | 1851686141
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Entity Type | Individual
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Provider Name | DENISE KRUCZYK OT
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Gender | Female
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Dates
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Enumeration Date | 06/14/2011
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Last Update Date | 06/14/2011
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Provider Practice Location Address
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Address Line | 55264 NILE WAY
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City | MACOMB
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State | MI
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Zip | 48042-6194
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Country | US
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Telephone | 586-337-0436
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Fax | 586-992-8919
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Provider Business Mailing Address
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Address Line | 48566 PENROSE LN
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City | MACOMB
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State | MI
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Zip | 48044-5550
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Country | US
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Telephone | 586-337-0436
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Fax | 586-992-8919
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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 | 5201003693
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License Number State | MI
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