Provider Demographics
NPI:1063668135
Name:RZASA, MARTHA JEAN (OTR)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JEAN
Last Name:RZASA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 AUTUMN CREST CIR
Mailing Address - Street 2:#E
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-8181
Mailing Address - Country:US
Mailing Address - Phone:719-598-8934
Mailing Address - Fax:
Practice Address - Street 1:610 AUTUMN CREST CIR
Practice Address - Street 2:#E
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-8181
Practice Address - Country:US
Practice Address - Phone:719-598-8934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD913363NBCOTA225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist