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NPI Code Detail

MEDICARE: NANCY ELLEN KROLIKOWSKI O.T.

MEDICARE: NANCY ELLEN KROLIKOWSKI O.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist5201002623MI

General Provider Information

NPI Number : 1760603427
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY ELLEN KROLIKOWSKI O.T.
Provider Business Mailing Address
First Line : 7971 MOORSBRIDGE RD
Second Line :
City : PORTAGE
State : MI
Zip : 49024-4075
Country : US
Telephone Number : 269-321-0929
Fax Number : 269-321-1767
Provider Business Practice Location Address
First Line : 7971 MOORSBRIDGE RD
Second Line :
City : PORTAGE
State : MI
Zip : 49024-4075
Country : US
Telephone Number : 269-321-0929
Fax Number : 269-321-1767
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 12/10/2012

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