Provider Demographics
NPI:1689604183
Name:JUZWA, MICHAEL (OT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:JUZWA
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7637 HEYWARD CIR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34201-2050
Mailing Address - Country:US
Mailing Address - Phone:941-587-8703
Mailing Address - Fax:
Practice Address - Street 1:7637 HEYWARD CIR
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34201-2050
Practice Address - Country:US
Practice Address - Phone:941-587-8703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9265225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT9265OtherMEDICAL LICENSE