Provider Demographics
NPI:1619446168
Name:MAZAN, CAROLYN (OTR)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:MAZAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16817 LARCH WAY UNIT E201
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3367
Mailing Address - Country:US
Mailing Address - Phone:847-809-5927
Mailing Address - Fax:
Practice Address - Street 1:3602 EVERETT AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3818
Practice Address - Country:US
Practice Address - Phone:425-230-6113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics