Provider Demographics
NPI:1811532203
Name:KAZMIERCZAK, SEBASTIAN (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:
Last Name:KAZMIERCZAK
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11066 WINTER CREST DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-2015
Mailing Address - Country:US
Mailing Address - Phone:216-905-9413
Mailing Address - Fax:
Practice Address - Street 1:5035 E BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-5310
Practice Address - Country:US
Practice Address - Phone:813-631-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-09
Last Update Date:2019-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist