Provider Demographics
NPI:1891494449
Name:KOZDRA, JOANNA ANNA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:ANNA
Last Name:KOZDRA
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 1:8320 98TH ST APT 3L
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1634
Mailing Address - Country:US
Mailing Address - Phone:917-693-5721
Mailing Address - Fax:
Practice Address - Street 1:2613 21ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3544
Practice Address - Country:US
Practice Address - Phone:718-626-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014681225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist