Provider Demographics
NPI:1457440539
Name:NEZOVICH, THOMAS (OTR)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:NEZOVICH
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 BROOKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-1902
Mailing Address - Country:US
Mailing Address - Phone:216-749-0029
Mailing Address - Fax:
Practice Address - Street 1:2434 BROOKDALE AVE
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-1902
Practice Address - Country:US
Practice Address - Phone:216-749-0029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist