Provider Demographics
NPI:1083151286
Name:RAJEK, MARY JO (OT/L)
Entity Type:Individual
Prefix:
First Name:MARY JO
Middle Name:
Last Name:RAJEK
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-2535
Mailing Address - Country:US
Mailing Address - Phone:608-203-2273
Mailing Address - Fax:
Practice Address - Street 1:2030 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-2535
Practice Address - Country:US
Practice Address - Phone:608-203-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5924-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist