Provider Demographics
NPI:1770684763
Name:DWORZANOWSKI, KIM OANH (COTA)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:OANH
Last Name:DWORZANOWSKI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 CHELSEA DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3314
Mailing Address - Country:US
Mailing Address - Phone:706-736-0901
Mailing Address - Fax:
Practice Address - Street 1:830 LAURENS ST
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3416
Practice Address - Country:US
Practice Address - Phone:803-649-6264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2629224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant