Provider Demographics
NPI:1114225133
Name:ZAGATA, KRISTY DUKARSKI
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:DUKARSKI
Last Name:ZAGATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:DUKARSKI
Other - Last Name:ZAGATA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTRL
Mailing Address - Street 1:2694 FRASER RD
Mailing Address - Street 2:
Mailing Address - City:KAWKAWLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48631-9115
Mailing Address - Country:US
Mailing Address - Phone:989-450-5057
Mailing Address - Fax:
Practice Address - Street 1:2694 FRASER RD
Practice Address - Street 2:
Practice Address - City:KAWKAWLIN
Practice Address - State:MI
Practice Address - Zip Code:48631-9115
Practice Address - Country:US
Practice Address - Phone:989-450-5057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004083225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist