Provider Demographics
NPI:1669985768
Name:BURZYNSKI, ASHLEY LYNN (OTRL)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LYNN
Last Name:BURZYNSKI
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 1:16931 19 MILE RD STE 130
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4841
Mailing Address - Country:US
Mailing Address - Phone:586-978-2359
Mailing Address - Fax:
Practice Address - Street 1:42536 HAYES RD STE 100
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-3644
Practice Address - Country:US
Practice Address - Phone:586-978-2359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009460225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation