MEDICARE: JEANETTE CZARNIK

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
1	225X00000X	Occupational Therapist	116799	TX

General Provider Information

NPI Number	:	1982099099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE CZARNIK

Provider Business Mailing Address
First Line	:	1409 NE 4TH CT APT 1
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-1376
Country	:	US
Telephone Number	:	586-995-0504
Fax Number	:

Provider Business Practice Location Address
First Line	:	1409 NE 4TH CT APT 1
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-1376
Country	:	US
Telephone Number	:	586-995-0504
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2015
Last Update Date	:	04/06/2015

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Directions to “ JEANETTE CZARNIK ” Practice Location

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