Provider Demographics
NPI:1376943605
Name:MAZURAK, ALISON
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:MAZURAK
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 1:397 FOREST HILL DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1973
Mailing Address - Country:US
Mailing Address - Phone:313-570-4269
Mailing Address - Fax:
Practice Address - Street 1:397 FOREST HILL DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1973
Practice Address - Country:US
Practice Address - Phone:313-570-4269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist