Provider Demographics
NPI:1154602860
Name:KRAKOWIAK, KRYSTA LYNN (COTA/L)
Entity type:Individual
Prefix:MS
First Name:KRYSTA
Middle Name:LYNN
Last Name:KRAKOWIAK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-7206
Mailing Address - Country:US
Mailing Address - Phone:248-608-1386
Mailing Address - Fax:
Practice Address - Street 1:500 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-7206
Practice Address - Country:US
Practice Address - Phone:248-608-1386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202007368224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant