Provider Demographics
NPI:1215547740
Name:BRZAK, EMILIE JO (MS, OTRL)
Entity Type:Individual
Prefix:
First Name:EMILIE
Middle Name:JO
Last Name:BRZAK
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:EMILIE
Other - Middle Name:
Other - Last Name:SICKLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:608 E HIGHAM ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-1610
Mailing Address - Country:US
Mailing Address - Phone:517-648-2979
Mailing Address - Fax:
Practice Address - Street 1:3181 SANDHILL RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-9425
Practice Address - Country:US
Practice Address - Phone:517-336-6060
Practice Address - Fax:517-336-6050
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010674225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist