Provider Demographics
NPI:1306682232
Name:BERZINS, CLARE MARZEJON
Entity type:Individual
Prefix:
First Name:CLARE
Middle Name:MARZEJON
Last Name:BERZINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CLARE
Other - Middle Name:MARZEJON
Other - Last Name:BANONIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1803 KAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-1617
Mailing Address - Country:US
Mailing Address - Phone:269-903-7144
Mailing Address - Fax:
Practice Address - Street 1:1400 N DRAKE RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-1978
Practice Address - Country:US
Practice Address - Phone:269-903-7144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201011292225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist