Provider Demographics
NPI:1306200795
Name:ZUGAJ, MAXIMILLIAN (MOT, OTR)
Entity Type:Individual
Prefix:
First Name:MAXIMILLIAN
Middle Name:
Last Name:ZUGAJ
Suffix:
Gender:M
Credentials:MOT, OTR
Other - Prefix:
Other - First Name:MAX
Other - Middle Name:
Other - Last Name:ZUGAJ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MOT, OTR
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-8800
Mailing Address - Fax:
Practice Address - Street 1:700 SCOTT AND WHITE DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6441
Practice Address - Country:US
Practice Address - Phone:979-207-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114633225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist