Provider Demographics
NPI:1588033880
Name:LAZARSKI, JENNIFER LYN (COTA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYN
Last Name:LAZARSKI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2119 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-2221
Mailing Address - Country:US
Mailing Address - Phone:608-797-5186
Mailing Address - Fax:
Practice Address - Street 1:501 N LAKE ST
Practice Address - Street 2:
Practice Address - City:PESHTIGO
Practice Address - State:WI
Practice Address - Zip Code:54157-1013
Practice Address - Country:US
Practice Address - Phone:715-582-3906
Practice Address - Fax:715-582-3141
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI224Z00000X
MI5202007845224Z00000X
WI5044-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant