Provider Demographics
NPI:1245575380
Name:GAZDA, NICHOLAS MARTIN (COTA/L)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:MARTIN
Last Name:GAZDA
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 STATION ST
Mailing Address - Street 2:
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106-3014
Mailing Address - Country:US
Mailing Address - Phone:412-874-6728
Mailing Address - Fax:
Practice Address - Street 1:200 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1028
Practice Address - Country:US
Practice Address - Phone:412-489-3556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP003667L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant