Provider Demographics
NPI:1083800478
Name:RONJAK, LINDA (OT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:RONJAK
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 1:258 ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-1602
Mailing Address - Country:US
Mailing Address - Phone:219-926-8387
Mailing Address - Fax:847-441-0734
Practice Address - Street 1:110 BEVERLY DR
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-9368
Practice Address - Country:US
Practice Address - Phone:219-926-8387
Practice Address - Fax:847-441-0734
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002153A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist