Provider Demographics
NPI:1962042739
Name:BURZDAK, STEPHANY JEAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:STEPHANY
Middle Name:JEAN
Last Name:BURZDAK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 CHICOPEE ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01013-2148
Mailing Address - Country:US
Mailing Address - Phone:413-536-2540
Mailing Address - Fax:413-536-3571
Practice Address - Street 1:546 CHICOPEE ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-2148
Practice Address - Country:US
Practice Address - Phone:413-536-2540
Practice Address - Fax:413-536-3571
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4529224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant