Provider Demographics
NPI:1306131321
Name:PARADOWSKI, MARY TERESA
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:TERESA
Last Name:PARADOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:TERESA
Other - Last Name:OLIVERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:38574 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-3809
Mailing Address - Country:US
Mailing Address - Phone:734-595-6889
Mailing Address - Fax:
Practice Address - Street 1:38574 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-3809
Practice Address - Country:US
Practice Address - Phone:734-595-6889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202004919224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant