Basic Information
| Provider Information | |||||||||
| NPI: | 1174881809 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZIOLKOWSKI | ||||||||
| FirstName: | CARLA | ||||||||
| MiddleName: | AMANDA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1630 CHIPPEWA DR | ||||||||
| Address2: | |||||||||
| City: | RHINELANDER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545019503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153615480 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1630 CHIPPEWA DR | ||||||||
| Address2: | |||||||||
| City: | RHINELANDER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545019503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153615480 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2012 | ||||||||
| LastUpdateDate: | 10/24/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 5152-26 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.