Provider Demographics
NPI:1164596292
Name:ZAMORSKI, MARY (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:ZAMORSKI
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 1:172 BIRCHWOOD PASS
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-7751
Mailing Address - Country:US
Mailing Address - Phone:678-522-1078
Mailing Address - Fax:678-985-3953
Practice Address - Street 1:172 BIRCHWOOD PASS
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-7751
Practice Address - Country:US
Practice Address - Phone:678-522-1078
Practice Address - Fax:678-985-3953
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003695225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA965598604BMedicaid