Provider Demographics
NPI:1336912765
Name:ZMIJEWSKI, KASEY DIANA (OTRL)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:DIANA
Last Name:ZMIJEWSKI
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 MEADOW WOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-4500
Mailing Address - Country:US
Mailing Address - Phone:248-461-2543
Mailing Address - Fax:
Practice Address - Street 1:27655 MIDDLEBELT RD STE 130
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-5029
Practice Address - Country:US
Practice Address - Phone:248-939-4030
Practice Address - Fax:248-939-4239
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201013650225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty