Provider Demographics
NPI:1972770535
Name:KUCZMARSKI, RAMONA (OT)
Entity type:Individual
Prefix:
First Name:RAMONA
Middle Name:
Last Name:KUCZMARSKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 BOYCE DR
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3836
Mailing Address - Country:US
Mailing Address - Phone:715-365-6865
Mailing Address - Fax:715-365-6713
Practice Address - Street 1:903 BOYCE DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3836
Practice Address - Country:US
Practice Address - Phone:715-365-6865
Practice Address - Fax:715-365-6713
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1310026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41055700Medicaid