Provider Demographics
NPI:1164884839
Name:ZIELKE, MARTA
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:ZIELKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5909 69TH AVE
Mailing Address - Street 2:2 FLOOR APT.
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-4453
Mailing Address - Country:US
Mailing Address - Phone:347-421-5874
Mailing Address - Fax:
Practice Address - Street 1:5909 69TH AVE
Practice Address - Street 2:2 FLOOR APT.
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-4453
Practice Address - Country:US
Practice Address - Phone:347-421-5874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020338225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist