Provider Demographics
NPI:1609833946
Name:BOCZARSKI, CAROL S (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:S
Last Name:BOCZARSKI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3471 DEERFIELD LN NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1888
Mailing Address - Country:US
Mailing Address - Phone:770-792-5986
Mailing Address - Fax:678-290-0173
Practice Address - Street 1:3471 DEERFIELD LN NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1888
Practice Address - Country:US
Practice Address - Phone:770-792-5986
Practice Address - Fax:678-290-0173
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002232225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
52748023002OtherBC/BS
GA0091987AMedicaid
65BBBZLMedicare ID - Type Unspecified